The health care proxy for mental illness: can it work and should we want it to?

The living will was first proposed more than 20 years ago,' and for almost that long commentators have suggested that it and other types of advance directives* could be used in the treatment of individuals with mental i l l n e ~ s . ~ The uses offered for advance directives vary considerably depending on the philosophy and goals of the commentator. Psychiatrists and families of mentally ill individuals propose advance directives as a means to facilitate hospitalization or pharmacological treatment of mentally ill patients or family members."' Health care consumers and their advocates take a more cautious approach but still envision advance directives as a