Advance directives in psychiatry to foster self-determination: a proposal for the Italian scenario

Psychiatric advance directives (PADs) are statements that allow people with mental disorders to express their preferences and wishes in anticipation of future crisis situations in which the patient's decision-making capacity may be compromised due to their mental disorder. The fundamental value of PADs is the promotion of self-determination and personal autonomy. Although PADs have common elements, they may differ across countries in their content, development process and legal status. Italy does not have a specific regulation regarding PADs; however, we argue that important indications may be drawn from Law No. 219/2017 regulating informed consent, advance directives and shared care planning (SCP). Moving from the international context and empirical evidence regarding barriers and facilitators to the implementation of PADs, the paper provides a key for interpreting SCP in the psychiatric field. The discussion highlights the importance of an interdisciplinary collaboration among bioethics, law, and clinics to improve the quality and consistency of care for people with mental disorders.