Opportunities and challenges of self-binding directives: an interview study with mental health service users and professionals in the Netherlands

被引:2
作者
van Melle, Laura [1 ]
van der Ham, Lia [1 ]
Voskes, Yolande [1 ]
Widdershoven, Guy [1 ]
Scholten, Matthe [2 ]
机构
[1] Vrije Univ Amsterdam, Dept Ethics Law & Humanities, Amsterdam UMC, Amsterdam, Netherlands
[2] Ruhr Univ Bochum, Inst Med Eth & Hist Med, Markstr 258a, D-44799 Bochum, Germany
关键词
Self-binding directive; Ulysses contract; Ulysses arrangement; Psychiatric advance directive; Advance statement; Crisis plan; Mental healthcare; Psychiatry; Coercion; ADVANCE DIRECTIVES; ULYSSES ARRANGEMENTS; CARE; PSYCHIATRISTS; DISORDER; LEGAL;
D O I
10.1186/s12910-023-00915-y
中图分类号
B82 [伦理学(道德学)];
学科分类号
摘要
BackgroundSelf-binding directives (SBDs) are psychiatric advance directives that include the possibility for service users to consent in advance to compulsory care in future mental health crises. Legal provisions for SBDs exist in the Netherlands since 2008 and were updated in 2020. While ethicists and legal scholars have identified several benefits and risks of SBDs, few data on stakeholder perspectives on SBDs are available.AimsThe aim of the study was to identify opportunities and challenges of SBDs perceived by stakeholders who have personal or professional experience with legally enforceable SBDs.MethodsData collection was carried out in the Netherlands from February 2020 to October 2021 by means of semi-structured interviews. Participants were selected through purposive sampling and snowball methods. Interviews were conducted with mental health service users (n = 7), professionals (n = 13), and an expert on SBD policy (n = 1), resulting in a total number of 21 interviews. The data were analyzed thematically.ResultsPerceived benefits of SBDs included increased autonomy, improvement of the therapeutic relationship, possibility of early intervention and prevention of harm, prevention of compulsory care, reduction of the duration of compulsory care and recovery, mitigation of negative experiences around compulsory care, and guidance for professionals in providing compulsory care. Perceived risks included infeasibility of SBD instructions, difficulty in decision-making around SBD activation, limited accessibility of SBDs, disappointment of service users due to non-compliance with SBDs, and limited evaluation and updating of SBD content. Barriers to SBD completion included lack of knowledge of SBDs among professionals, lack of motivation or insight among service users, and lack of professional support for SBD completion. Facilitators of SBD completion and activation included support for SBD completion, involvement of relatives and peer experts, specification of SBD content, and evaluation of compulsory care and SBD content. The new legal framework was regarded as having both positive and negative effects on SBD implementation.ConclusionsStakeholders who have personal or professional experience with legally enforceable SBDs perceive SBDs as having important benefits and tend not to articulate the fundamental ethical concerns about SBDs which can be found in the ethics and legal literature. Instead, they perceive ethical and practical challenges that can be addressed through the implementation of suitable safeguards.
引用
收藏
页数:11
相关论文
共 29 条
  • [1] Anderson N, 2003, WASH LAW REV, V78, P795
  • [2] Models of advance directives in mental health care: Stakeholder views
    Atkinson, JM
    Garner, HC
    Gilmour, WH
    [J]. SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, 2004, 39 (08) : 673 - 680
  • [3] Choosing to limit choice: Self-binding directives in Dutch mental health care
    Berghmans, Ron
    van der Zanden, Marja
    [J]. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY, 2012, 35 (01) : 11 - 18
  • [4] Ulysses Arrangements in Psychiatric Treatment: Towards Proposals for Their Use Based on 'Sharing' Legal Capacity
    Bielby, Phil
    [J]. HEALTH CARE ANALYSIS, 2014, 22 (02) : 114 - 142
  • [5] Mental Health Service Users? Perspectives on Psychiatric Advance Directives: A Systematic Review
    Braun, Esther
    Gaillard, Anne-Sophie
    Vollmann, Jochen
    Gather, Jakov
    Scholten, Matthe
    [J]. PSYCHIATRIC SERVICES, 2023, 74 (04) : 381 - 392
  • [6] Braun V., 2012, APA handbook of research methods in psychology, VVolume 2, P57
  • [7] Self-binding directives for mental health treatment: when advance consent is not effective consent
    Del Villar, Katrine
    Ryan, Christopher J.
    [J]. MEDICAL JOURNAL OF AUSTRALIA, 2020, 212 (05) : 208 - +
  • [8] BOUND TO TREATMENT - THE ULYSSES CONTRACT
    DRESSER, R
    [J]. HASTINGS CENTER REPORT, 1984, 14 (03) : 13 - 16
  • [9] DRESSER RS, 1982, HARVARD CIVIL RIGHTS, V16, P777
  • [10] The Content of Psychiatric Advance Directives: A Systematic Review
    Gaillard, Anne-Sophie
    Braun, Esther
    Vollmann, Jochen
    Gather, Jakov
    Scholten, Matthe
    [J]. PSYCHIATRIC SERVICES, 2023, 74 (01) : 44 - 55