Jeffrey W Swanson
Publications [#137748] of Jeffrey W Swanson
- JW Swanson, S Van McCrary, MS Swartz, RA Van Dorn, EB Elbogen, Overriding psychiatric advance directives: factors associated with psychiatrists' decisions to preempt patients' advance refusal of hospitalization and medication.,
Law and human behavior, vol. 31 no. 1
pp. 77-90, ISSN 0147-7307 [doi]
(last updated on 2013/05/16)
Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.
Adult • Advance Directives • Aged • Aged, 80 and over • Crisis Intervention • Decision Making* • Drug Therapy • Female • Health Care Surveys • Hospitalization* • Humans • Male • Mental Disorders • Mental Health Services • Middle Aged • Physician-Patient Relations* • Professional Autonomy* • Psychiatry • Treatment Refusal* • United States • drug therapy • epidemiology • legislation & jurisprudence* • rehabilitation • statistics & numerical data • utilization