Advanced Health Directive - choosing treatment for when you are too unwell to choose

I am not sure if that is what other countries call this legal document. Essentially, it is a legal document that you complete when stable to dictate what future treatment can or can not be used should you become unable to make those decisions for yourself. Your psychiatrist must explain and discuss it with you but in the end the treatment choices are yours.

My pdoc suggested this to me six weeks ago but I am only now getting around to looking in to it. It came up as I nearly lost my life while psychotic in February and I was terrified of it happening again, and how I would be treated at a state hospital if locked up. Apparently I can decide whether or not I will allow myself to be restrained, have ECT, and things such as certain meds that mess me up.

It seems like a good idea but now I am stable it is difficult to see the need for it. Still. I am looking into it. I am finding it difficult to make certain decisions like would I allow myself to be physically restrained. Well, I would hate that. It would traumatise me as I expect some people here have already been through.

However, if I say never restrain me I place myself in great danger from myself should I become that unwell. Only chance and timing saved me in February. I really want to live. I love life. Yet, how do I make these massive decisions, and what details do I include?

I am not asking anyone for the answers to these personal questions. I am just curious if anyone here has this kind of legal document completed, and interested on anyone's thoughts on this issue.

I’ve got one of those documents in place because I’ve got so many physical/medical conditions. So mine are along the lines of “not to be resuscitated in the event of....”.
However, I don’t have any psych clauses in place. I probably should.

I have the document from the past, but never fully completed it. My husband said that in my state it may be necessary to provide it to a lawyer. I'm not sure of that, and think that's likely not necessary in many states. I know that there will come a time when I should fill out a Psychiatric Advanced Directive, and a living will.

I think "psychical restraint" is not a completely clear thing. I know that I have been dragged into isolation rooms, given injections while being held down, and locked in the isolation room for some hours, more than a couple of times. Those times are quite fuzzy in my memory, but I remember enough about a couple of the times to know that it was necessary for my good, but definitely the good of the other patients. What I mean by the latter is that some of my behavior must have been frightening to some patients. Being in a locked psych ward is stressful enough for patients, but seeing another patient screaming scary stuff, being violent towards (something/one), etc., is definitely not good. But certainly excessive or abusive physical restraint is another story. Also, I have had ECT. Of course I want to be able to decide if/when I will ever have ECT again, if needed. But if I was deliriously psychotic manic or catatonic, I may not be able to make such a decision. In my view, if I couldn't make a decision on ECT, I, personally, would rather have ECT administered than need to be totally drugged out of my mind or strapped to a bed in an isolation room, really long-term. Mania itself (pure or mixed) or certain particularly horrible depressions, can be traumatic and physically and mentally damaging in and of themselves. It's sometimes hard to know or weigh what may be the best approach to stabilization. I guess I do hope that a psychiatrist will make a right choice. I know that some hospitals have a much better reputation than others. I know that in the Psychiatric Advanced Directive form I have that hospital choice is an option.

PADs and living wills vary from state to state. It's good to get it written down, notarized and on file at all the clinics and doctors you use.

I have to consider this. I have a health POA and a living will, but not an advance directive. I’m going to talk to my spouse, since he would want the same. I don’t know if my health POA covers psychiatric issues. I don’t think it does.

SAMHSA have a great over view on PADs and you can download copies.

Thanks for all the feedback. I’m in Australia so laws here may be different. Still, I’m sure I would have to submit it to my pdoc and have it listed at the various hospitals I may be taken too. For me ECT has been damaging and never helpful so I would never want that forced on me. It’s so hard to think of everything I want listed, to be thorough. The main reason I want to do it is to save my life without undue trauma.

I really need to get it in black and white and through a lawyer. ( psych)

But my husband and my daughter know what treatments I would be willing to use while IP if I were unable to make decisions. No ECT, ever. I’m fine being medicated to the gills until I’m safe and can make medical decisions with my treatment team.

There is no use of restraints at my IP, they have a couple “ quiet “ rooms that are soundproof, calming sounds, a psych tech stays with you. I was given a large dose of Xanax to help settle me down , You only leave when your calmed down and ready. I have needed this twice during a IP stay.

For general medical ... this is where things are not cut and dry. If I have a medical emergency like massive stroke , aneurysm etc I would want to be a DNR. But if I were to OD then I would want all the help possible because obviously I wasn’t in my right mind.

My husband is well aware of what I want and don’t want. But in reality my husband could legally over ride my wishes if he just could not sign away my life.

The PC member that I welcomed into my home had what turned out to be a huge reaction to a increased in Seroquil that basically put her in a coma since I was POA for and her living will was DNR. I was presented with paperwork to sign. It was really shocking to see the papers and to actually sign them but I did.

Theres no easy way to pick and choose what we want done so many variables .We can only hope that our loved ones know when to keep fighting for us and when it’s time to let go.

This is a good topic to bring up.

Thank you OP

This thread is exactly what I am looking for. I to am in Australia and in need of a POA as well as living will. It all seems so daunting, yet when last hospitalised a few weeks ago, I realised I really had nothing in place other than a clinical treatment plan that escalated steps until legally I handed control over to my treating Pdoc.

This now scares me as it leaves me vulnerable to any and all treatments deemed necessary. If it keeps me alive though until stable, maybe this is the best approach. I'll be so out of it. But ECT, restraints, overmedicated, losing control of financial, legal...i need to do something. It all started with not knowing who to put as an emergency contact sitting in ED.