Psychiatric advance directives: potential challenges in India

Area of Science:

• Mental Health Law
• Psychiatry
• Bioethics

Background:

• Advance directives, initially for end-of-life care, are now considered for mental health treatment.
• The UN Convention on the Rights of Persons with Disability supports advance directives.
• India is reviewing its mental illness legal framework, prompting a review of psychiatric advance directives.

Purpose of the Study:

• To review evidence on psychiatric advance directives (PADs).
• To examine challenges in making PADs legally binding in India.
• To inform the ongoing legal reforms for mental healthcare in India.

Main Methods:

• Review of existing evidence on advance directives in mental health.
• Analysis of international models, including Ulysses contracts.
• Examination of feasibility and acceptability barriers in the Indian context.

Main Results:

• International experience with PADs is mixed, with scant evidence of improved care.
• The concept of PADs has received little attention in India.
• Significant logistical and operational barriers exist for implementing legally mandated PADs, including quality assurance and misuse prevention.

Conclusions:

• While valuable for collaborative decision-making, PADs require further development before legal enforcement in India.
• Addressing barriers to feasibility and acceptability is crucial.
• More research and discourse are needed on mental health advance directives in India.