Mental Health America of Virginia The voice of reason in mental health advocacy

Screen 11: Treatment Over My Objection

Once you have identified an agent and the treatments you want or don't want, you have an important decision to make-what happens when you don't agree with your agent's decisions but you don't have the capacity to make your own decisions? Remember that if you have capacity, you make all of your own decisions and the agent only steps in when you don't have capacity. So, in this situation, you don't have capacity, your agent makes a decision, and you disagree. What happens to the instructions you put in writing in your advance directive? You must choose now what will happen in that situation. Some people know that when they are not doing well, they do not make the best decisions for themselves and their recovery from a crisis is delayed because of that. People who realize this pattern can write their advance directive in a way that allows the agent to make decisions even over their protest as long as they do not have the capacity to make their own decisions. Other people do not want to give up the right to protest their agent's decisions.

Let's look at two examples. Tom completes this tutorial and has a completed and signed advance directive giving his agent the power to make decisions even if he disagrees as long as he lacks the capacity to make his own decisions. Tom has been hospitalized several times in the past and he knows that when he is unwell, he refuses to take all medications. His hospital stays are usually quite long and very disruptive to his life. Once he gets treatment and starts feeling better, he wishes he had just accepted the treatment earlier and gotten on with his life. He always vows to do just that the next time he is in crisis, but the pattern just repeats itself. He wants his agent to step in and consent to the medications he needs to get better faster and he has specified those medications in his advance directive. If he ever goes back to the hospital, he will receive the medications he needs even over his protest.

Tom's friend Sally also completed this tutorial and has a completed and signed advance directive. However, she did not choose to give her agent the power to make decisions over her protest. She wants to be able to object to treatment and object to her agent's authority to make decisions for her at all times, even when she does not have capacity to make her own health care decisions. She has also been in the hospital a few times and she feels she knows her body and her needs better than anyone else. She wants to avoid forced treatment if at all possible. She knows the hospital can go to court to get the judge to order treatment, but she will deal with that when and if it ever happens.

Both Tom and Sally made their decision based on their own past experiences and their knowledge of their own process. Neither decision is right or wrong. This is an easy choice for some people and a difficult one for others. If you choose to give your agent this power, there will be a place on the form for your physician or licensed psychologist to sign stating that you understand your decision and the possible consequences.

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