THE USE OF ADVANCE DIRECTIVES BY
PERSONS WITH SERIOUS MENTAL ILLNESS
FOR PSYCHIATRIC TREATMENT
Jeffrey L. Geller, M.D., M.P.H.
Objective. A health care proxy is an advance directive that allows an individual
to indicate in writing who can act on his behalf when he lacks the capacity to
make health care decisions, and what limitations he is placing on this authority.
Of great interest in medical settings, health care proxies are beginning to receive
more attention in psychiatric settings. Are these proxies useful when applied
to psychiatric treatment decisions? This paper examines health care proxies in
Massachusetts and their potential use for decisions about psychiatric interven-
tions at one Massachusetts state hospital. Method. A point in time study of a
state hospital’s entire census was done by reviewing all patients’ records for
demographic, diagnostic, and legal data, and for the presence and content of the
state required health care proxy form. Results. Of the 161 patients in the hospi-
tal, 71 (44%) had full guardians and were ineligible to complete their own prox-
ies. Of the remaining 90 patients, 53 (33% of the total population) had a proxy
form in their chart, but 34 (21%) of these patients refused to sign them. Of the
19 (12%) signed proxies, 16 (10%) of the patients were deemed competent to
have executed meaningful health care proxies. Conclusions. This preliminary
analysis reveals that only 10% of a state hospital population had meaningful
health care proxies. Further outcome studies are needed to determine if the
process of offering health care proxies and the presence of properly executed
proxies are meaningful and beneﬁcial to chronically ill psychiatric patients.
Address correspondence to Jeffrey Geller, M.D., M.P.H., Professor of Psychia-
try, University of Massachusetts Medical School, Department of Psychiatry, 55
Lake Avenue North, Worcester, MA 01655; e-mail: firstname.lastname@example.org.
PSYCHIATRIC QUARTERLY, Vol. 71, No. 1, Spring 2000
0033-2720/00/0300-0001$18.00/0 2000 Human Sciences Press, Inc.