There is very little case law regarding ADs and even less regarding PADs or mental health provisions in ADs, said Robert J. Fleischner, an attorney for the Center for Public Representation, a protection and advocacy public interest law firm representing people with mental illness in Massachusetts. The question in some states is whether documents that instruct an agent to refuse a certain medication can be trumped by a court order to the contrary. Promoting Use of PADs Despite this lack of legal certainty, there are many efforts to provide information about these documents. These efforts include those by the Bazelon Center for Mental Health Law and initiatives in the states of New York and Washington. Next year the National Mental Health Association plans to launch a nationwide initiative to help consumers complete their own PAD or AD with psychiatric provisions.
Experts agree that the documents offer many benefits.
In addition to requesting certain medications, people can include directives requesting hospitalization in certain situations, said Paul Sherman, Ph.D., a psychologist on the faculty of the University of Colorado. He pointed out, however, that health insurance companies may not necessarily approve payment. Other potential benefits inherent in PADs and ADs for psychiatric care include permission for psychiatrists to contact family members, empowerment of consumers, and reduced hospitalization and crises, said Maggie Bennington-Davis, M.D., president of the Oregon Psychiatric Association and chair of its legislation committee. With regard to legal benefits, these documents could help avoid court-ordered treatment and negate the need for lengthy court proceedings to appoint a guardian or approve intrusive treatment including involuntarily medicating patients, said Dennis Feld, J.D., and Hilliard, respectively. Feld is a deputy chief attorney for the New York State Mental Hygiene Legal Service.