Superseding Psychiatric Advanced Directives in Electroconvulsive Therapy

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Many harmed by electroconvulsive therapy (ECT) want to protect themselves from involuntary ECT in the future.

One way to do this is by creating a psychiatric advanced directive (PAD), which is a document that outlines their wishes regarding psychiatric treatment.

How do Psychiatric Advanced directives work?

PADs are legal documents that allow people to state their wishes for medical care in advance in case they are unable to communicate those wishes later on.

However, current state laws allow doctors to ignore patient advance directives if they conflict with their view of what the best medical care should be. Insurers may also refuse to pay for alternative treatments requested in a patient advance directive.

Unfortunately, psychiatric advance directives cannot guarantee that a person will not be subjected to involuntary shock therapy.

The 2006 article “Superseding Psychiatric Advance Directives: Ethical and Legal Considerations,” published in the Journal of the American Academy of Psychiatry and the Law, explains how care providers can easily override them.

Topics Covered 

  • What psychiatric advance directives are
  • How PADs work in theory vs practice
  • The mental health system and laws at play in these scenarios 
  • Philosophical, ethical, and legal reasons for overriding PADs
  • Incentives for interested parties to override PADs

Click here to read the article.

Additional resources

PAD template examples


Anna is a childhood psychiatric drug and a teenage electroshock survivor. She founded Life After ECT to ensure people injured by electroconvulsive therapy have easy access to resources that can help them understand their injuries and find a path to recovery.