Psychiatric advance directives, autonomy, and choice: an interdisciplinary perspective from law, ethics, and medicine
Bibliographic record
Abstract
Individuals with mental illness have a legal and ethical right to complete advance treatment planning documents in Canada. Psychiatric advance directives (PADs) are one type of legal document used in parts of the United States that enable individuals to declare their treatment preferences in the event of future mental incapacity. This dissertation consists of seven chapters that critically examine the relationship between PADs and autonomy from the perspective of Canadian mental health law. Chapter 1 argues that the operational elements of autonomy as it relates to PADs need further research. Chapter 2 argues that the self-binding nature of Ulysses contracts, where individuals make their wishes irrevocable, could be permissible under certain situations. Chapter 3 is a mixed method study involving 65 individuals with bipolar disorder, schizophrenia, or depression that examines preferences for instructional or proxy directives and the relationship to autonomy, empowerment, and recovery. The qualitative study in chapter 4 explores among 12 individuals with mental illness how factors such as trust and the strength of one's social contacts are relevant in choosing a substitute decision-maker. Chapter 5 is a comparative investigation into the legislative approaches surrounding advance treatment planning and finds there is substantial variation across Canadian jurisdictions. The relevance of mental capacity legislation (chapter 6) and civil commitment (chapter 7) are discussed in relation to advance treatment planning. For individuals with mental illness to be more involved in the process of advance treatment planning there needs to be legislative reform towards promoting autonomy, empowerment, and choice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.019 | 0.122 |
| Scholarly communication | 0.017 | 0.008 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.007 | 0.011 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".