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Advance directives and nominated representatives: A critique
Sharad Philip1, Subhashini K Rangarajan1, Sydney Moirangthem1
1Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India.
Indian Journal of Psychiatry
|May 2, 2019
Summary
India
Area of Science:
- Mental Health Law
- Disability Rights
- Healthcare Policy
Background:
- India ratified the UN Convention on Rights of Persons with Disabilities, necessitating mental health legislation reform.
- The Mental Healthcare Act, 2017, introduced a presumption of mental capacity, shifting the client-provider dynamic.
- Advance Directives (ADs) empower individuals in mental healthcare decision-making and consent for future treatments.
Purpose of the Study:
- To review the concept and implications of advance directives (ADs) in mental healthcare within the Indian context.
- To analyze the potential benefits and challenges of Psychiatric Advance Directives (PADs) in India.
- To examine the current evidence and future prospects of ADs in Indian mental healthcare.
Main Methods:
- Literature review focusing on advance directives in mental healthcare.
- Analysis of the Indian Mental Healthcare Act, 2017 provisions related to ADs.
- Examination of international experiences with ADs in mental health.
Main Results:
- Psychiatric ADs (PADs) can enhance information exchange and shared decision-making.
- Challenges include financing of directed care and potential non-compliance by insurance companies or families.
- Evidence on the effectiveness of ADs in developed countries remains mixed after decades of use.
Conclusions:
- The Mental Healthcare Act, 2017, enables PADs in India, representing a significant shift in patient autonomy.
- Successful implementation requires addressing financial planning and ensuring family/provider support.
- Further research is needed to evaluate the practical impact and efficacy of PADs in India.
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