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Is A Psychiatric Advance Directive Right For You?

In the event they’re incapacitated and unable to make decisions themselves, many people include health care powers of attorney or advance directives in their estate plans. And although it’s less well known, a psychiatric advance directive (PAD) also is worth considering, especially if your family has a history of mental illness. These directives are created so people have some influence over critical medical decisions when or if the need arises.

Health Care Directives
To cover all the health care bases, have two documents: an advance health care directive (sometimes referred to as a “living will”) and a health care power of attorney (HCPA). Some states allow you to combine the two in a single document.

An advance directive expresses your preferences for the use of life-sustaining medical procedures and specifies the situations in which these procedures should be used or withheld.

A document prepared in advance can’t account for every scenario or contingency. However, it’s wise to pair an advance directive with an HCPA. This allows you to authorize your spouse or other trusted representative to make medical decisions or consent to medical treatment on your behalf if you’re unable to do so.

Why A PAD?
Many states allow generic HCPAs and advance directives to address mental as well as physical health issues. But some states limit or prohibit mental health treatment decisions by general health care representatives. Around half of the states have PAD statutes, which authorize special advance directives to outline one’s wishes with respect to mental health care and appoint a representative to make decisions regarding that care.

PADs may address a variety of mental health care issues, including:

  • Preferred hospitals or other providers
  • Treatment therapies and medications that may be administered
  • Treatment therapies and medications that may not be administered, such as electroconvulsive therapy or experimental drugs
  • A statement of general values, principles, or preferences to follow in making mental health care decisions
  • Appointment of a representative authorized to make decisions and carry out your wishes with respect to mental health care in the event you’re incapacitated.


Although requirements vary from state to state, to be effective, a PAD must be signed by you and your chosen representative, and in some states by two witnesses. Be sure to discuss the terms of the PAD with your family, close friends, physician, and any mental health care providers. And to be sure that the PAD is available when needed, give copies to all of the above persons, keep the original in a safe place, and let your family know where to find it.

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