TY - JOUR
T1 - Self-binding directives in psychiatric practice: a systematic review of reasons
AU - Stephenson, Lucy
AU - Owen, Gareth
AU - Gergel, Tania
AU - Astrid, Gieselmann
AU - Scholten, Matthe
AU - Jakov, Gather
N1 - Funding Information:
JG and MS report funding from the German Federal Ministry of Education and Research (grant number 01GP1792). LS, TG, and GO report funding from Wellcome (grant number 203376). We thank Alex Ruck Keene for advice on legal issues pertaining to self-binding in England and Wales. We thank Scott Kim and for advice on the PRISMA systematic review process. We thank Penelope Weller for advice on the PRISMA systematic review process. The funding sources had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Further details of coding and analysis can be made available by request to LS.
Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/11
Y1 - 2023/11
N2 - Self-binding directives (SBDs) are an ethically controversial type of advance decision making involving advance requests for involuntary treatment. This study systematically reviewed the academic literature on psychiatric SBDs to elucidate reasons for and against their use in psychiatric practice. Full-text articles were thematically analysed within the international, interdisciplinary authorship team to produce a hierarchy of reasons. We found 50 eligible articles. Reasons for SBD use were promoting service user autonomy, promoting wellbeing and reducing harm, improving relationships, justifying coercion, stakeholder support, and reducing coercion. Reasons against SBD use were diminishing service user autonomy, unmanageable implementation problems, difficulties with assessing mental capacity, challenging personal identity, legislative issues, and causing harm. A secondary finding was a clarified concept of capacity-sensitive SBDs. Future pilot implementation projects that operationalise the clarified definition of capacity-sensitive SBDs with safeguards around informed consent, capacity assessment, support for drafting, and independent review are required.
AB - Self-binding directives (SBDs) are an ethically controversial type of advance decision making involving advance requests for involuntary treatment. This study systematically reviewed the academic literature on psychiatric SBDs to elucidate reasons for and against their use in psychiatric practice. Full-text articles were thematically analysed within the international, interdisciplinary authorship team to produce a hierarchy of reasons. We found 50 eligible articles. Reasons for SBD use were promoting service user autonomy, promoting wellbeing and reducing harm, improving relationships, justifying coercion, stakeholder support, and reducing coercion. Reasons against SBD use were diminishing service user autonomy, unmanageable implementation problems, difficulties with assessing mental capacity, challenging personal identity, legislative issues, and causing harm. A secondary finding was a clarified concept of capacity-sensitive SBDs. Future pilot implementation projects that operationalise the clarified definition of capacity-sensitive SBDs with safeguards around informed consent, capacity assessment, support for drafting, and independent review are required.
KW - psychiatric advance directive, ethics, mental health, advance decision, advance choice, Ulysses contract
UR - http://www.scopus.com/inward/record.url?scp=85173134892&partnerID=8YFLogxK
U2 - 10.1016/S2215-0366(23)00221-3
DO - 10.1016/S2215-0366(23)00221-3
M3 - Article
SN - 2215-0366
VL - 10
SP - 887
EP - 895
JO - The Lancet Psychiatry
JF - The Lancet Psychiatry
IS - 11
ER -