Patients’ Civil Liberties: Improving Policies While Keeping the Patient at the Center

Back to table of contents Next article Taking IssueFull AccessPatients’ Civil Liberties: Improving Policies While Keeping the Patient at CenterMatthew L. Goldman, M.D., M.S., Lilanthi Balasuriya, Marvin S. Swartz, M.D.Matthew GoldmanSearch for more papers by this author, BalasuriyaSearch SwartzSearch M.D.Published Online:1 Jan 2021https://doi.org/10.1176/appi.ps.72103AboutSectionsView articleView PDFView EPUB ToolsAdd favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articlePlacing a patient on either an involuntary psychiatric hold or form guardianship surrogate decision making is one most solemn duties mental health professional. To preempt person’s autonomy responsibility that clinicians must approach with great care. The justifications such measures can be variable: some patients suffer from decisional incapacity loss insight, whereas others experience cognitive impairment. These conditions constrain clinician’s ability respect autonomy, while serving other principles justice and beneficence. With regard principle nonmaleficence, clinician also determine commitment likely do good than harm.This issue Psychiatric Services includes two timely articles, Lee Cohen (1) Doyle et al. (2), shed light policies related suspension in holds default making. studies highlight wide state-to-state variability these consequential policies. demonstrates both definition rates vary significantly across states data reporting are spotty difficult interpret. authors advocate standardized definitions terms collection would sharpen understanding inpatient civil commitment.Doyle al.’s study examines differences state statutes define treatment—situations where no maker has been designated. They found 30 restrict type treatment surrogates may authorize completely prohibit decisions about treatment. In cases, made family member, court-appointed guardian, patient’s physician, none whom aware true preferences. This thoughtfully outlines significant statutory particularly salient implications disparities reinforces worrisome stigma against persons illnesses.These demonstrate affect service utilization, engagement, recovery. State laws their criteria (e.g., danger self, others, grave disability) imminence potential harm. Furthermore, as whether symptoms attributable treatable condition substance use disorders medical conditions. Even though best trained make determinations, many empower law enforcement officials, who have little training managing crises, place people holds. underresourced systems, function even leverage access complexity regional variation, there risk exacerbating racial-ethnic disparities.The transparency accountability ill served poor-quality collection. Although common practices care, absence consistent assurance processes executed thoughtful, patient-centered, evidence-based manner respects justice, equity.Doyle seeking patient-centered approaches imperative ensure illness afforded equitable proxy par One recommended Substance Abuse Mental Health Administration National Alliance Illness advance directives (PADs), legal documents allow preferences competent, future crisis accompanied incapacity. promote support recovery, provide opportunity align goals Novel software application tools recently developed increase PADs https://smiadviser.org/mymhcp?utm_source=SAMHSA_social).There still much determined role A fundamental question remains unanswered: how outcomes comparison alternative approaches? Pros cons weighed. consistency policies, accountability, evaluation—including clear focus equity—is crucial first step used only when necessary.Department Psychiatry Behavioral Sciences, University California, San Francisco, Francisco (Goldman); Yale Clinical Scholars Program, School Medicine, New Haven, Connecticut (Balasuriya); Duke Durham, North Carolina (Swartz).Send correspondence Dr. Goldman ([email protected]).References1 G, D: Incidences detentions 25 US states. Psychiatr Serv 2021; 72:61–68Abstract, Google Scholar2 CK, DeMartino ES, Sperry BP, al.: Statutes governing 2020; 72:s201900320Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 72Issue 1 January 01, 2021Pages 1-2 Metrics History Published online 2021 print