Abstract
Anticipatory planning for psychiatric care and treatment differs from routine end-of-life care planning. Validity of wishes and directives is difficult to establish and to interpret and may change due to the course of the disease. Models of advance care documents include Ulysses Contracts, and community-based or provider-based standards, use of the concept of Precedent Autonomy, and forms of proxy consent. Preparing care documents is a methodological and communicative challenge within an environment of professional paternalism. Narrative forms to elicit patient’s preferences and negotiated contracts are the methods of choice. While more detailed empirical and conceptual research is needed, the classical conflict in professional responsibility to balance the respect for patient’s self-determination with paternalism within a paternalistic model most likely will remain, calling for practical and compassionate reasoning and care.
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Sass, HM., May, A.T. (2010). Advance Directives: Balancing Patient’s Self-Determination with Professional Paternalism. In: Helmchen, H., Sartorius, N. (eds) Ethics in Psychiatry. International Library of Ethics, Law, and the New Medicine, vol 45. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8721-8_10
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