The paper makes several concrete policy recommendations based on detailed historical, legal, clinical, ethical and empirical analysis.
The recommendations aim to:
Enable a culture change in relation to written statements made with capacity such that they are developed within mental health services and involve joint working on mental health requests as well as potential refusals.
Enable mental health Advance Decisions to Refuse Treatment (ADRT) with limitations reflecting legitimate public interests.
Develop mental health attorneys using a “nominated person” system
Give service users more insurance that well thought through mental health advance decision making documents will be respected.
Key issues (physical vs. mental illness, self-determination vs public interest, Mental Capacity Law vs. Mental Health Law) converge in this study. In England and other jurisdictions advance decision making looks set to play an increasingly important role in health policy and practice debates.