Advance care planning for people with mental illness: Ethics and law

This paper will examine the legal and ethical principles that frame advance care planning in psychiatry. Internationally, nations with health systems similar to Australia have introduced psychiatric advance care planning. This is commonly facilitated by legislative provision. In Australia, psychiatric advance care planning may proceed on the same legal basis as advance care planning for other health matters.

Although often overlooked, advance care planning in psychiatry, in most instances, raises similar issues, and similar anxieties, to those raised by advance care panning in other contexts. However, psychiatric advance care planning takes place in the context of the potential, or actual, exercise of the involuntary treatment powers contained in mental health laws. Legislative recognition of psychiatric advance care planning is usually necessary to establish the appropriate relationship between advance care plans and involuntary treatment powers. Pertinent law reform in Australia is likely to occur in the near future. With or without new law, psychiatric advance care planning in the involuntary context raises unique legal and ethical problems for clinicians.

This presentation recognises that the establishment of a robust culture of advance care practice in psychiatry is facilitated by a clear appreciation of the law. It will address the legal and ethical issues raised by advance care planning for both voluntary and involuntary patients with a view to facilitating the development of sound advance care practice. The clarification of the special issues raised in psychiatry will contribute to the development of advance care practice in the wider context.