Advance directives and nominated representatives: A critique

With the ratification of the landmark United Nations Convention on Rights of Persons with Disabilities by India, it was imperative to revamp the mental health-care legislation, among other changes. Most notably, a presumption of mental capacity has been introduced, which means a paradigm shift in th...

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Published inIndian journal of psychiatry Vol. 61; no. 10; pp. 680 - 685
Main Authors Philip, Sharad, Rangarajan, Subhashini, Moirangthem, Sydney, Kumar, Channaveerachari, Gowda, Mahesh, Gowda, Guru, Math, Suresh
Format Journal Article
LanguageEnglish
Published India Wolters Kluwer India Pvt. Ltd 01.04.2019
Medknow Publications and Media Pvt. Ltd
Medknow Publications & Media Pvt. Ltd
Medknow Publications & Media Pvt Ltd
Subjects
Advance directives
Advertising executives
Cognitive ability
Decision making
Human rights
Legislation
Medical law
Mental disorders
Mental health
Nominations
Palliative care
People with disabilities
Review
India
nominated representative
Advance directives
India
Mental Healthcare Act 2017
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Summary:With the ratification of the landmark United Nations Convention on Rights of Persons with Disabilities by India, it was imperative to revamp the mental health-care legislation, among other changes. Most notably, a presumption of mental capacity has been introduced, which means a paradigm shift in the client and provider relationship. The Mental Healthcare Act, 2017 empowers all persons to make advance directives (AD) and nominate representatives for shared decision-making. Psychiatric ADs (PADs) also seem to improve the information exchange between the care provider and the service user. PADs may also be used as a vehicle of consent to future treatments. While drafting the PAD, the drafter must also plan how such directed care would be financed. Insurance companies have not been mandated to comply with ADs. In the eventuality that the drafter's family refuse support for treatment specified in the PAD, the drafter would be left holding an unimplementable PAD. The AD saw its origins in the care of the terminally ill and decades later came to be utilized in mental health care. After nearly three decades of use in developed countries, evidence at best remains mixed or inconclusive. This review focuses on the AD from the Indian perspective.
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ISSN:0019-5545
1998-3794
DOI:10.4103/psychiatry.IndianJPsychiatry_95_19