Dr. Lorcan Martin:

It would be very useful. We welcome these types of directives and patients willing preference. The difficulty arises when somebody loses insight. That is the big problem, when they no longer have the ability to make a decision. Advance care directives can be extremely helpful in managing somebody when they are no longer able to make the decision in a capacitous way. The difficulty arises if somebody says, for example, that they do not want to be treated with antipsychotic medication, and they then become psychotic. We obviously cannot abide by the advance care directive at that point. If someone says they do not want to be treated with a certain medication because it gives them side-effects, that is a very reasonable thing to look at, but to say they do not want to be treated with medication when the only treatment that is likely to ameliorate their condition is medication is a different story.

Our primary aim is to alleviate suffering and treat illness. Advance care directives and those levels of patient involvement are important and helpful.