ÿWPC ñ¬žÕoE8úY;úYñL¨RÐæ-e;gÚ#Òi v±Û¼¡âSÝd)žß¼¦Ðµò¶bà 5ùQIN·´7chÔýÎÁ2^Él ʛkCÛaEÃoÄÄé‡ÙKpr[™z¢Lq4¤øJÚ&Òw%\ÏõIÐýÔ2á`÷ërYÿ´Ú?æ Å/¡S} ˆ­(§S:KŸ2UØ6]7$µ‚Æ !™”ù–a—ª£‚îHмû>UþWFç4‹);ð!E3›×§ö+…B\9ÏE˜@·°ê”cAoUq‰d_šK©q¡µ®"AçSr¢mªû·OÁåʦ)Èà”¦œ©áÿû(…x5Ä9õÒS Ø£uJŸ“Dë§õÒ~,?a¹2bÔ­¼x°’“v0™B—Mgâ§à¸Õë•—/F̲‹–©*ë«%äîÎù‘ÄN3¯†íb;9fî9ÛBªª´uLõ˜ÊÍÊâHëD)Áb/¢{+Û:Ùižýä>X@á#AÑ“g. fQ4 ó¬IOàaöW?/»t›KD\«¿ÈÉ7 õRätà¹Âç¡Â2絓Š&Œ0k,¶ÆŠþЭPø‹úhÀêú‚aÞ¸jñïVÏV<5U@æ %&Ä, 0]ðM-cn«  0BKKw@4Íá mãßúULÙU0% ÆU Æ Æá Ƨ Æm 0^3 ‘ U>™ E× UNÙ U8'UL___U<«««««««««« 0^çççç BEEE A©bb D+  0K6*Ͼ¦ `(CG TimesScalableX ºÝ ƒ¾Æ)ÝÒܰÒÓ  ÓÝ  Ý›ò ò€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ó ó€(52¾Æ$©©Ý ƒ †‹!ÝÒܰÒÓ  ÓÝ  Ý Ñ ‡ Ñ #Ñ#€Xd#Ñ#|[^ «*Ͼ¦ `(CG TimesScalableXXwϾ¦ P쉊7ûXP(†‹$¡¡ÒܰÒÓ  Ó U DV W DX EY EZ [ D\ D] U^ Dð‰y,Highligh´ªƒÿU‹ÿÀÀÀ ÕÝ ƒ+¡'ÝÒܰÒÓ  ÓÝ  Ý›òòAdvance€DirectivesÐ  ÐSelected€Articles€and€CasesÌßA€.) °°xd½EÜùLAßóóÐ úà Ð`-Î â iZ ‹4Brush Script MT Italicx°À`  ZCG TimesLevel 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5ƒLevel 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5(63+¡$§§Ý ƒ †‹!ÝÒܰÒÓ  ÓÝ  Ý xÖÃ9 Z‹&Times New RomanxÖÃ9 Z‹6Times New Roman Regular„†r‰AZ‹ Arial ItalicxÖÃ9 Z‹4Times New Roman Italicô\  `$Times NewRoman(63+¡$££Ý ƒ †‹!ÝÒܰÒÓ  ÓÝ  Ý d*43›&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKK'ÈÈÈÈdxd( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó óÝ ƒ †‹!ÝÒܰÒÓ  ÓÝ  ݛѰÑÖ€ÿÿÖòòÖ€ÿÿÖÑ  ÑÑ8€“XXdðdÈ8ÑÑ€ð+ÑÌÌÌÌÌÌÓ  ÓòòÔ€X -XÐXÔÔ‡XòÄXÐX -ÔÔ‡„]a„ÐXòÄÔBibliography€ofóóÐ Ú À ÐCases€and€Materials€on€Advance€DirectivesÌfor€People€with€Mental€IllnessÌÌÔ#†XòÄX8„]a#ÔÌA€selection€of€articles€and€case€summariesÌregarding€advanced€directivesÌÓ  ÓÔ#†X -XÐXòÄû#ÔÌÌÌÌÌÌÌÌÔ‡ôjp õÐX -Ôà 4 àà Œ àà ä àà < àà ” àÔ#†X -X XôjpN#ÔÔ‡ôjp õÐX -Ôà ì àòòÔ‡ôå† õ XôjpÔPrepared€for€ATTAC€of€NAPASÐ òØ Ðà 4 àà Œ àà ä àà < àà ” àà ì àBy€Center€for€Public€RepresentationÔ#†X“X Xôå†Ì#ÔÐ âÈ Ðà 4 àà Œ àà ä àà < àà ” àà ì àÔ#†X -XÐX“ú#ÔóóÌÔ‡X XÐX -ÔÌMarch€2002ÌÔ#†X -X ÐX[#ÔÌÌÓ  ÓÌÌÌÐ Ò*¸&¤ ÐÑð+Ñâ âчÈÑâ âÑ  ÑÌÔ‡XxfXÐX -ÔÔ‡ôgÑõÐXxfÔIntroductionÐ  L ÐÌÓ  Óà 4 àThis€bibliography€is€designed€to€assist€P&A€advocates€to€locate€materials€and€casesÏabout€advance€health€care€directives.€The€materials€listed€include€most€of€what€we€can€findÏabout€advance€directives€for€people€with€mental€illness.€Those,€unfortunately,€€represent€onlyÏa€small€part€of€the€quickly€growing€body€of€work€available€about€ADs€generally.€NotÏsurprisingly,€most€of€the€writing€€and€litigation€involves€the€use€of€directives€at€or€near€deathÏand€a€great€deal€is€of€it€is€wrapped€up€in€the€ongoing€debate€about€assisted€suicide.€We€haveÏchosen€to€include€some€of€those€materials€that€we€think€are€relevant€to€mental€healthÏdirectives€and€which€may€be€useful€in€thinking€about€how€the€law€of€mental€health€careÏadvance€directives€will€develop€and€evolve.€We€have€also€included€citations€to€some€importantÏmaterials€on€competence€to€consent€to€treatment,€since€that€is€a€concept€which€underlies€theÏentire€AD€process.ÌÌà 4 àHowever,€the€government€has€funded€some€research€into€the€effectiveness€of€mentalÏhealth€directives€and€a€recent€symposium€issue€of€Psychology,€Public€policy€and€Law€devotedÏto€¢ADs£,€including€mental€health€directives,€has€been€published,€so€the€available€materials€areÏgrowing.ÌÌà 4 àPlease€let€us€know€if€there€are€citations€which€should€be€included.€The€Center€forÏPublic€Representation€provides€back„up€services€to€P&As€and€will€be€pleased€to€assist€in€anyÏway€possible.ÌÌà 4 àà Œ àà ä àà < àà ” àà ì àBob€FleischnerÌà 4 àà Œ àà ä àà < àà ” àà ì àCenter€for€Public€RepresentationÌà 4 àà Œ àà ä àà < àà ” àà ì à22€Green€St.Ìà 4 àà Œ àà ä àà < àà ” àà ì àNorthampton,€MA€01060Ìà 4 àà Œ àà ä àà < àà ” àà ì à413„587„6265Ìà 4 àà Œ àà ä àà < àà ” àà ì à¢RFleischner£@¢cpr£„¢ma.org£ÌÌMarch€2002Ô#†XxfXXôgÑ8#ÔÔ#†X -XÐXxf#ÔÐ µ$ô ÐÐ  ¡%à  Ðñ^ ñÐ  Á Ðñ^ ñÔ‡XxfXÐX -Ôà@ÎÎ0‚àAdvance€DirectivesóóˆÐ Á Ðà@N N *‚àSELECTED€BIBLIOGRAPHY€AND€CASESˆÌÌÌà@¦¦5‚àARTICLESˆÌÓ  Ó(Articles€directly€related€to€mental€health€directives€are€preceded€by€an€*)ÌÓ  ÓÌÌ*¢Amering£,€Michael,€€Elisabeth€¢Denk£,€¢Hemma£€¢Griengl£,€Ingrid€¢Sibitz£,€Peter€¢Stastny£,ð ðPsychiatricÏWills€of€Mental€Health€Professionals:€A€Survey€of€Opinions€Regarding€Advance€Directives€inÏPsychiatry,ðð€34€Social€Psychiatry€and€Psychiatric€Epidemiology€30€(1999)€(Ô#†X -XXXxfç #ÔÔ‡ XxfXXX -ÔThe€authorsÐ )h  Ðconclude€that€there€is€an€interest€and€positive€attitude€towards€¢ADs£€among€mental€healthÏprofessionals.€Professionals€felt€inclined€to€make€very€specific€statements€as€to€which€availableÔ(#(#(#ÔÐ @  Ðtreatment€strategies€they€would€reject€and€request€for€their€own€treatment.Ô#†X -XX Xxf2#ÔÔ‡XxfXXX -Ô)Ð í,  ÐÔ‡ôgÑõXXxfÔ€Ô(#(#(#  ÔÔ#†XxfXõôgÑú#ÔÔ#†X -XXXxfÅ#ÔÔ‡X“XXX -ÔÐ Ù  ÐAnnas,€George,€"The€Health€Care€Proxy€and€the€Living€Will,"€324€New€¢Engl£.€J.€Med.Ï1210€(1991)Ìà0 4 àà0Œ 4(#4(#àà0ä Œ (#Œ (#àà0<ä (#ä (#àà0”<(#<(#àà0ì”(#”(#àà0Dì(#ì(#àà0œD(#D(#àà0ôœ(#œ(#àà0Lô(#ô(#àà0¤L(#L(#àà0ü!¤(#¤(#àÐ ü!(#ü!(# ÐÖ€ðÖ*¢Applebaum£,€Paul,€"Advance€Directives€for€Psychiatric€Treatment,"€42€Hosp.€&€Comm.€€€ÏPsychiatry€983€(1991)ÌÌ*¢Backlar£,€Patricia,€ð ðAnticipatory€Planning€for€Research€Participants€with€PsychoticÐ A€ ÐDisorders€Like€Schizophrenia,ðð€4€Psychology,€Public€Policy,€and€Law€829€(1998)Ô#†X -XXX“u#ÔÔ‡X“XXX -ÔÐ 1p ÐÌÔ#†X -XXX“m#ÔÔ‡X“XXX -Ô*¢Backlar£,€Patricia,€ð ðÔ#†X -XXX“Å#ÔÔ‡X“XXX -ÔAnticipatory€Planning€for€Psychiatric€Treatment€is€not€Quite€the€SameÐ P Ðas€Planning€for€End„of„Life€Care,ðð€33€Community€Mental€Health€J.€261€(1997)Ð @ ÐÌ*¢Backlar£,€Patricia,€ð ðThe€Longing€for€Order:€Oregonððs€Medical€Advance€Directive€forÐ á  ÐMental€Health€Treatment,ðð€31€Community€Mental€Health€J.€103€(1995)Ð Ñ! ÐÌ*¢Backlar£,€Patricia,€¢Asniann£,€B.D.,€€¢Joondeph£,€¢Robert.C.£,ð ðCan€I€Plan€Now€for€MentalÐ ±#ð ÐHealth€Treatment€I€Would€Want€if€I€Were€in€Crisis?€A€Guide€to€Oregonððs€Declaration€forÏMental€Health€Treatment,ðð€(summarized€on€KEN,€¢www.mentalhealth.org£)(available€fromÐ ‘%Ð  Ðthe€Oregon€Advocacy€Center)ÌÔ#†X -XXX“!#ÔÔ‡X“XXX -ÔÌ*¢Backlar£,€Patricia€&€¢McFarland£,€B.€H.,€"A€Survey€of€Use€of€Advance€Directives€forÏMental€Health€Treatment€in€Oregon,"€47€Psychiatric€Services€1387€(1996)ÌÌ*¢Backlar£,€Patricia€&€¢McFarland£,€B.€H.,€"Ô#†X -XXX“?#ÔÔ‡X“XXX -ÔOregonððs€Advance€Directive€for€Mental€HealthÐ 1+p#& ÐTreatment:€Implications€for€Policy,ðð€25€Administration€&€Policy€in€Mental€Health€609Ð !,`$' Ð(1998)ÌÌBarnes,€A.P.,€"Florida€Guardianship€and€the€Elderly:€The€Paradoxical€Right€to€Unwanted€ÏAssistance,"€40€U.€Fla.€L.€Rev.€949,€988€(1988)€ÌÌBaron,€Charles,€"Medical€Paternalism€and€the€Rule€of€Law:€A€Reply€to€Dr.€¢Relman£,"€4Ï¢A.J.L.£€&€€€Med.€337€(1979)ÌÌBowers,€¢V.J.£,€Elder€Law€Symposium,€ð ðAdvance€Directives:€Peace€of€Mind€of€FalseÐ A€ ÐSecurity?ðð€26StetsonL.Rev.677€(1996)Ð 1p  ÐÌBradley,€Elizabeth€H.€&€John€A.€¢Rizzo£,€ð ðPublic€Information€and€Private€Search:Ð P  ÐEvaluation€of€the€Patient€Self„Determination€Act,ðð€24€J.€Health€Pol.€¢Polððy£.€&€L.€239Ð @  Ð(1999)ÌÌBrett,€"Limitations€of€Listing€Specific€Medical€Interventions€in€Advance€Directives,"€266€ÏJ.€Am.€Med.€Assoc.€825€(1991)ÌÌ*Brown,€S.J.,€"An€Idea€Whose€Time€Has€Come:€Advanced€Directives€Move€Into€MentalÏHealth€Care,"€Clinical€Psychiatry€News,€July€10„11,€1995.€ÌÌBuchanan,€¢A.E.£,€"The€Limits€of€Proxy€Decisionmaking€for€Incompetents,"€29€¢UCLA£€L.ÏRev.€386€(1981)ÌÌBuchanan,€¢A.E.£,€"Advance€Directives€and€the€Personal€Identity€Problem,"€17€Phil.€&ÏPub.€Affairs€277€(1988)ÌÌBuchanan,€¢A.E.£€&€Brock,€¢D.W.£,€òòDeciding€for€Others:€The€Ethics€of€Surrogate€DecisionÐ !P ÐMakingóó,€1989Ð "@ ÐÌ¢Cate£,€¢F.H.£,€ð ðImplementing€the€Education€Mandate€of€the€Patient€Self„Determination€Act,ððÐ á#  Ð7€Health€Lawyer€11€(Fall€1993)ÌÌChambers,€C.V.€et€al.,€"Relationship€of€Advance€Directives€to€Hospital€Charges€in€aÏMedicare€Population,"€154€Achieves€Internal€Med.€541€(1994)ÌÌChoice€in€Dying€(formerly€Society€for€the€Right€to€Die),€"Refusal€of€TreatmentÏLegislation,€€1991,"€(updated€annually)€(250€W.€57th€Street,€N.Y.,€NY€10107)Ð  q*°"% Ð*Clayton,€Roger€R.€et€al.,€ð ðSurvey€of€Illinois€Law:€Health€Care€Law,ðð€22€Green€Street€S.Ð Á ÐIll.€¢U.L.R.£€939€(1998).ÌÌCohen„Mansfield,€¢Rabinovich£,€Lipson,€Fein,€Gerber,€¢Weisman£€&€¢Pawlson£,€"The€DecisionÏto€Execute€a€Durable€Power€of€Attorney€for€Health€Care€&€Preferences€Regarding€theÏUtilization€of€Life„Sustaining€Treatments€in€Nursing€Home€Residents,"€151€ArchivesÏInternal€Med.€289€(1991).ÌÌ*Cross,€John,€Fleischner,€Robert,€&€Elder,€Jinanne€N.,€ð ðHealth€Care€Proxies:€SpecialÐ A€ ÐProblems€in€Psychiatric€Treatment,ðð€in€Guardianship€and€Conservatorship€inÐ 1p  ÐMassachusetts,€Lexis€Law€Publishers€(1997)ÌÌ*¢Cuca£,€Roberto.,€Note,€"Ulysses€in€Minnesota:€First€Steps€Toward€a€Self„BindingÏPsychiatric€Advance€Directive€Statute,"€78€Cornell€L.€Rev.€1152€(1993)ÌÌ*¢Daar£,€Melissa,€Nelson,€Theresa€and€Pone,€Daniel,€òòDurable€Power€of€Attorney€for€HealthÐ Ñ ÐCare€Manual:€An€Advocacy€Tool€for€Mental€Health€Consumer€Empowerment€and€PatientÏChoiceóó,€Protection€and€Advocacy,€Inc.€(CA)€(1994)€(Available€from€Protection€andÐ ±ð ÐAdvocacy,€Inc.)ÌÌ*¢Doudera£€&€¢Swazey£€(¢eds£.),€òòRefusing€Treatment€in€Mental€Institutions€„€Values€in€Conflict€óóÐ À Ð(1982)ÌÌ*Dresser,€R.S.,€"Bound€to€Treatment:€The€Ulysses€Contract,"€14€Hastings€Center€Rpt.€13Ï(1984)ÌÌ*Dresser,€R.S.,€"Ulysses€and€the€Psychiatrists:€A€Legal€and€Policy€Analysis€of€theÏVoluntary€Commitment€Contract,"€16€Harv.€C.R.„C.L.€Rev.€777€(1982)ÌÌDresser,€R.S.,€ð ðMissing€Persons:€Legal€Perceptions€of€Incompetent€Patients,ðð€46€RutgersÐ ñ"0 ÐL.€Rev.€609€(1994)ÌÌ*¢Dukoff£,€R,€T.€Sunderland,€ð ðDurable€Power€of€Attorney€and€Informed€Consent€withÐ Á%  ÐAlzheimerððs€Disease€Patients:€A€Clinical€Study,ðð€154€Am.€J.€Psychiatry€1070€(1997).Ð ±&ð! ÐÌ*¢Dunlap£,€Justin€A.,€ð ðMental€Health€Advance€Directives:€Having€Oneððs€Say?ðð€€89€Ky.€L.J.Ð ‘(Ð # Ð327€(2000„2001).ÌÌñ\ ñÌñ\ ñ*ñ\ ñ¢ñ\ ñ¢Ehrlichman£ñ\ ñ£ñ\ ñ,€"The€1990€Health€Care€Proxy€Law:€Beyond€the€Best€Interests€of€the€State,"Ï76€€Mass.€L.€Rev.€145€(1991)Ð Q,$' Ї¢Elster£,€J.€òòUlysses€and€the€Sirens:€€Studies€in€Rationality€and€Irrationalityóó€(1984)Ð Á ÐÌEmanuel,€¢E.J.£€&€Emanuel,€¢L.L.£,€"Proxy€Decision€Making€for€Incompetent€Patients,"€267Ï¢JAMA£€2067€(1992)ÌÌ*Equip€for€Equality,€Inc.,€The€Mental€Health€Treatment€Preference€Declaration,(1996)Ï(Guidebook€to€assist€individuals€with€mental€illness€and€their€families€in€understanding€theÏIllinois€mental€health€treatment€declaration€statute.€Available€from€Equip€for€Equality)ÌÌ*Fisher,€Daniel,€ð ðMaking€Advance€Directives€Work€for€You,ðð€Newsletter€of€the€NationalÐ 1p  ÐEmpowerment€Center,€Spring€1999€p.€13.ÌÌ*Fleischner,€Robert€D.,€ð ðAdvance€Directives€for€Mental€Health€Care:€An€Analysis€of€StateÐ @  ÐStatutes,ðð€4€Psychology,€Public€Policy,€and€Law€788€(1998)(Charting€all€state€statutes)Ð ñ0  ÐÌ*Gallagher,€Elizabeth,€ð ðAdvance€Directives€for€Psychiatric€Care:€A€Theoretical€andÐ Ñ ÐPractical€Overview€for€Legal€Professionals,ðð€4€Psychology,€Public€Policy,€and€Law€746Ð Á Ð(1998)Ô#†X -XXX“M#ÔÔ‡X“XXX -ÔÐ ±ð ÐÌ*Gallagher,€Elizabeth,€ð ðProviding€in€Advance€for€Treatment€Choices€with€PsychiatricÐ ‘Ð ÐAdvance€Directives,ðð€Envoy€Aug./Sept.€1995€(Washington€Protection€and€AdvocacyÐ À ÐSystem€newsletter)ÌÌ¢Garraty£,€C.M.,€Note,€ð ðDurable€Power€of€Attorney€for€Health€Care:€A€Better€Choice,ðð€7Ð Q ÐConn.€Probate€L.€J.€115€(1992)ÌÌGeneral€Accounting€Office€(GAO),€ð ðPatient€Self„Determination€Act:€Providers€OfferÐ ! ` ÐInformation€on€Advance€Directives€but€Effectiveness€Uncertain,ðð€(Letter€report,€9/1/95,Ð !P ÐGAO/¢HEHS£„95„135)ÌÌ¢Grisso£,€Thomas€&€¢Applebaum£€Paul€S.,€ð ðThe€MacArthur€Treatment€Competency€Study.Ð á#  ÐIII:€Abilities€of€Patients€to€Consent€to€Psychiatric€and€Medical€Treatments,ðð€19€L.€&€Hum.Ð Ñ$ ТBehav£.€149€(1995)(nearly€half€of€patients€with€schizophrenia€and€over€two„thirds€of€thoseÏwith€clinical€depression€performed€within€adequate€range€of€decision€making€abilities)ÌÌ¢Gustitus£,€T.,€Note€€€ð ðA€Comparative€View€of€Advance€Health€Care€Directives€in€FloridaÔ#†X -XXX“Ö.#ÔÔ‡X“XXX -ÔÐ ‘(Ð # Ðand€North€Carolina,ðð€11¢Quinnipiac£ProbateL.J.163€€€(1997)Ð )À!$ ÐÌ¢Haimowitz£,€S.€&€Goldman,€R.A.,€"A€Patient€Returns€from€`Death€with€Dignity':€Error,ÏUncertainty€and€the€Right€to€Die,"€N.Y.€State€Bar€J.€(Oct.€1990)€at€58Ð Q,$' Ї*¢Halpern£,€A.€&€¢Szmukler£,€G.,€ð ðPsychiatric€Advance€Directives:€Reconciling€AutonomyÐ Á Ðand€Non„consensual€Treatment,ðð€21€Psychiatric€Bulletin€323€(1997)Ð ±ð ÐÌHarrison,€P.,€ð ðAdvance€Health€Care€Directives,ðð€3€S.C.€Lawyer€29€(1991)€Ð ‘ Ð ÐÌHastings€Center,€"Practicing€the€¢PSDA£,"€Special€Supplement,€21€Hastings€Center€Report,ÏS„1€„€S„16€(1991)(Ten€articles€on€advance€directives)ÌÌHerr,€Stanley,€"Representation€of€Clients€with€Disabilities:€Issues€of€Ethics€and€Control,"ÏXVII€Rev.€of€Law€&€Social€Change€609€(1989„1990)ÌÌHoffman,€¢D.E.£,€ð ðThe€Maryland€Health€Care€Decisions€Act:€Achieving€the€Right€Balance?ðð€Ð P  Ð53€Md.€L.€Rev.€1051€(1994)ÌÌ*¢Hoge£,€Steven€K.,€"The€Patient€Self-Determination€Act€and€Psychiatric€€Care,"€22€Bull.ÏAm.€Acad.€Psychiatry€&€L.€577€(1994)ÌÌ*¢Honberg£,€Ronald€S.,€ð ðAdvance€Directives,ðð€11€Journal€of€NAMI€California,€alsoÐ ±ð Ðavailable€at€¢NAMInet£€<<¢www.nami.org£>>€ÌÌ*Jaffe,€D.J.,€ð ðHealth€Care€Proxies€and€a€potentially€ððeasierðð€way€to€get€someone€helpÐ À Ðbefore€they€become€a€danger€to€self€or€others,ðð€(several€short€articles€on€advanceÐ q° Ðdirectives,€available€at€http://¢www.schizophrenia.com£/ami/coping/¢proxy.html£)ÌÌJacobson,€J.A.€et€al.,€"Patient's€Understanding€and€Use€of€Advance€Directives,€"€160€W.ÏJ.€Med.€232€(1994)ÌÌ*€¢Kapp£,€M.,€ð ðImplications€of€the€Patient€Self„Determination€Act€for€Psychiatric€Practice,ððÐ !P Ð45€Hosp.€&€Community€Psychiatry€355€(1994)ÌÌKing,€N.,€òòMaking€Sense€of€Advance€Directivesóó,€Boston:€¢Klower£€Academic€Press€(1991)Ð á#  ÐÌ¢Krasik£,€"The€Role€of€the€Family€in€Medical€Decisionmaking€for€Incompetent€AdultÏPatients:€€A€Historical€Perspective€and€Case€Analysis,"€48€U.€Pitt.€L.€Rev.€539€(1987)ÌÌLarson,€¢E.J.£€and€€Eaton,€¢T.A.£,€ð ðThe€Limits€of€Advance€Directives:€A€History€andÐ ‘(Ð # ÐAssessment€of€the€Patient€Self„Determination€Act,ðð€€€32WakeForestL.Rev.249€(1997)Ð )À!$ ÐÌ¢Leflar£,€¢R.B.£,€ð ðAdvance€Health€Care€Directives€under€Arkansas€Law,ðð€1994€Ark.€L.€NotesÐ a+ #& Ð37Ð Q,$' Ї*¢Lentini£,€¢Cece£,€ð ðAdvance€directives:€A€New€Area€of€the€Law,ðð€4€The€Key€1€(SummerÐ Á Ð1998)(Newsletter€of€the€National€Mental€Health€Consumersðð€Self„Help€Clearinghouse)ÌÌ*¢Lieberson£,€Alan€D.,€ð ðCommentary:€Advance€Directives€ð"ð€1998:€A€Medical€View,ðð€12Ð ‘ Ð ТQuinnipac£€Prob.€L.€J.€305€(1998)ÌÌ*Macklin,€A.,€"Bound€to€Freedom:€€The€Ulysses€Contract€and€the€Psychiatric€Will,"€45ÏToronto€Fac.€L.€Rev.€37€(1987)ÌÌ*Massachusetts€Health€Care€Proxy€Task€Force,€ð ðConsensus€Report,ðð€1992€(available€fromÐ 1p  ÐMassachusetts€Health€Decision,€P.O.€Box€417,€Sharon.€MA€02067)ÌÌ*¢McArdle£,€Edward€F.,€ð ðAdvance€Directives€and€the€Treatment€of€Patients€with€MentalÐ @  ÐIllness:€Can€an€Advance€Directive€Avert€Court€Intervention€when€the€Patient€Refuses€theÏAdministration€of€Antipsychotic€Medication?ðð€29€Journal€of€Psychiatry€and€Law€__€(2001).Ð á  ÐÌ*McLean€Hospital,€ð ðInformation€on€Advance€Directives:€Health€Care€Proxies€and€DurableÐ Á ÐPowers€of€Attorney,ðð€1991€(booklet€provided€to€patients€upon€admission€to€McLeanÐ ±ð ÐHospital,€Belmont,€MA)€ÌÌ"Medical€Decision„Making€and€the€'Right€to€Die'€after€Cruzan,"€19€Law,€Medicine€&€€€€€ÏHealth€Care€(Special€edition€1991)ÌÌрѢMeisel£,€Alan,€The€Right€to€Die,€Wiley€Law€(1989)€(annual€supplements)ÌÌ¢Milani£,€¢A.A£,,€€€ð ðBetter€Off€Dead€than€Disabled:€Should€Courts€Recognize€a€€"WrongfulÐ 1p ÐLiving"€Cause€of€€Action€when€Doctors€Fail€to€Honor€Patients'€Advance€Directives?ðð€€Ð ! ` Ð54Wash.&LeeL.Rev.149€€€(1997)€ÌÌ*Miller,€Robert€D.,€ð ðAdvance€Directives€for€Psychiatric€Treatment:€A€View€from€theÐ ñ"0 ÐTrenches,ðð€€4€Psychology,€Public€Policy,€and€Law€728€(1998)Ô#†X -XXX“z3#ÔÔ‡X“XXX -ÔÐ á#  ÐÌ*Miller,€Robert€D.,€ð ðPatient€Responsibilities;€The€Other€Side€of€the€Coin,ðð€17€T.M.Ð Á%  ÐCooley€L.€Rev.€91€(2000).ÌÌMower,€W.R.€&€¢Baraff£,€L.J.,€"Advance€Directives:€Effect€of€Type€of€Directive€onÏPhysician's€Therapeutic€Decisions,"€153€Archives€of€Internal€Med.€153€(1993)ñ] ñÌñ] ñÌñU ñÌ¢ñU ñ¢Mulholland£ñU ñ£ñU ñ,€K.C.,€Recent€Developments,€ð ðProtecting€the€Right€to€Die:€The€Patient€Self„Ð a+ #& ÐDetermination€Act,ðð€28€Harv.€J.€on€Legis.€609€(1991)Ð Q,$' ÐÑ Ñâ âÑ8€“XXdðXXdð8Ñâ âÑ  ÑÌNational€Health€Lawyers€Association,€"The€Patient€Self„Determination€Directory€&ÏResource€€Guide,"€(1991)€¢NHLA£,€1620€I€Street.,€NW,€#900,€Washington,€DC€20006Ì¢Orentlicher£,€"The€Illusion€of€Patient€Choice€in€End„of„Life€Decisions,"€267€¢J.A.M.A.£€101€Ï(1992)ÌÌ*¢Perling£,€Lester€J.,€"Health€Care€Advance€Directives:€Implications€for€Florida€MentalÏHealth€Patients,"€48€U.€Miami€L.€Rev.€193€(1993)ÌÌPeters,€"Advanced€Medical€Directives:€The€Case€for€the€Durable€Power€of€Attorney€forÏHealth€Care,"€8€J.€of€Legal€Medicine€437€(1987)ÌÌ*¢Pinkney£,€D.S.,€"Advance€Directive€Could€Give€Mentally€Ill€More€Treatment€Control,"ÏAm.€Med.€News,€Dec.€16,€1991,€at€3ÌÌ¢Posner£,€N.B.,€Comment,€€ð ðThe€End€of€Parens€Patriae€in€New€York:€Guardianship€UnderÐ Ñ Ðthe€New€Mental€Hygiene€Law€Article€81,ðð€79€¢Marq£.€L.€Rev.€603€(1996)Ð Á ÐÌ*¢Raddan£,€J.,€"Planning€for€Mental€Disorder:€Buchanan€and€Brock€on€Advance€DirectivesÏin€Psychiatry,"€18€Soc.€Theory€&€¢Prac£.€165€(1992)ÌÌ¢Rhoden£,€¢N.K.£,€ð ðLitigating€Life€and€Death,ðð€102€Harv.€L.€Rev.€375€(1988)Ð q° ÐÌ*¢Rissmiller£,€David€J,€Erica€¢Musser£,€Walter€¢Rhoades£,€Frances€R.€¢Rissmiller£,€Robert€A.ÏSteer,€ð ðA€Survey€of€the€Use€of€a€Durable€Power€of€Attorney€to€Admit€¢Geropsychiatric£Ð A€ ÐPatients,ðð€52€Psychiatric€Services€98€(2001)(About€half€the€facilities€surveyed€havñV ñeñV ññW ñañW ñ€policyÐ 1p Ðto€allow€admission€by€a€health€care€agent;€37€percent€believed€it€is€optional€to€AD€or€civilÏcommitment€to€force€admission€of€demented€patients;€47€percent€believed€such€patientsÏcould€be€admitted€against€their€will€only€by€use€of€civil€commitment.)ÌñX ñÌñX ñÌ*Rosenfeld,€Elizabeth€Ann,€Note,€ð ðMental€Health€Advance€Directives:€A€False€Sense€ofÐ á#  ÐAutonomy€for€the€Nationððs€Aging€Population,ðð€9€Elder€L.€J.€53€(2001)Ð Ñ$ ÐÌ*¢Rosenson£,€¢M.K.£€&€¢Kasten£,€A.M.,€"Another€View€of€Autonomy:€Arranging€for€ConsentÏin€Advance,"€12€Schizophrenia€Bull.€1€(1991)ÌÌ¢Sabatino£€&€¢Gottlich£,€"Seeking€Self„Determination€in€the€Patient€Self„Determination€Act,"€Ï25€Clearinghouse€Rev.€639€(1991)ÌÌ*Sales,€¢G.N.£,€"The€Health€Care€Proxy€for€Mental€Illnesses:€Can€It€Work€and€Should€WeÐ Q,$' ÐWant€it€To?"€21€Bull.€Am.€Acad.€Psychiatric€Law€161€(1993)(summarized€on€KENÏ¢www.mentalheath.org£)ÌÌSachs,€Miles€&€Levin,€"Emergencies€and€Advance€Directive,"€20(6)€Hastings€CenterÏReport€€42€(Nov/Dec€1990)ÌÌSchlesinger,€S.J.€and€¢Scheiner£,€B.J.,€€Practicing€Law€Institute€Tax€Law€and€EstateÏPlanning€Course€Handbook€Series,€€Estate€Planning€and€Administration€€Ï¢PLI£OrderNo.D4„5231€€òòHandling€Your€First€Health€Care€Proxy,€Living€Will€andÐ A€ ÐDurable€Power€of€Attorney€óó(1992)Ð 1p  ÐÌ¢Sehgal£,€Galbraith€et€al.,€"How€Strictly€Do€Dialysis€Patients€Want€Their€AdvanceÏDirectives€€Followed?"€267€JAMA€59€(1992)ÌÌ¢Sheafor£,€C.M.,€Recent€Development,€ð ðMissouri€Health€Care€Durable€Power€of€Attorney,ððÐ á  Ð70€Wash.€¢U.L.Q.£€973€(1992)ÌÌ*Sherman,€Paul€S.,€"Advance€Directives€for€Involuntary€Psychiatric€Care,ðð€SymposiumÐ ±ð ÐProceedings:€Involuntary€Interventions€„€The€Call€for€a€National€Legal€and€MedicalÏResponse,€Univ.€of€Texas/Houston,€Health€Science€Center€(1994)ÌÌ*Sherman,€Paul€S.,€ð ðBrief€on€Advance€Directives€for€Involuntary€Psychiatric€Care,ððÐ q° Ð(summarized€on€KEN€www.mentalhealth.org)(available€from€author)ÌÌ*Sherman,€Paul€S.,Ô#†X -XXX“¨D#ÔÔ‡X“XXX -Ô€ð ðComputer„Assisted€Creation€of€Psychiatric€Advance€Directives,ðð€34Ð A€ ÐCommunity€Mental€Health€J.€351€(1998)ÌÌ*Sherman,€Paul€S.,€ð ðOn€the€Advantages€to€¢Funders£€and€MCOs€of€Sponsoring€the€CreationÐ !P Ðof€Advance€Directives€for€Psychiatric€Care.ðð€(summarized€on€KENÐ "@ Ðwww.mentalhealth.org)(available€from€author)ÌÌ*Sherman,€Paul€S.,€ð ðToolkit€for€Creating€Advance€Directives€for€HealthÐ Ñ$ ÐCare.ðð(summarized€on€KEN€www.mentalhealth.org)(available€from€author)Ð Á%  ÐÌShort,€D.,€"A€Physician's€Misgivings€Regarding€the€Advance€Directive,"€Ethics€&€Med.Ï(Spring€1993)€at€7ÌÌ¢Shugrue£,€R.E.,€ð ðThe€Patient€Self„Determination€Act,ðð€Annual€Eight€Circuit€Survey,€26Ð q*°"% ТCreighton£€L.€Rev.€751€(1993)ÌÐ Q,$' Ð*¢Srebnik£,€Debra€S.€and€¢LaFond£,€¢J.Q.£,€ð ðAdvance€Directives€for€Mental€Health€Treatment,ððÐ Á Ð50€Psychiatric€Services€919€(1999)€(Surveying€information€and€suggesting€future€research.)ÌÌ¢Stachura£,€M.E.€"The€Rhode€Island€Health€Care€Power€of€Attorney€and€the€Living€Will:€AÏComparative€Overview,"€43€R.I.€Bar€J.€15€(1995)ÌÌ*¢Stavis£,€Paul€F.,€ð ðThe€Health€Care€Proxy€Law:€Is€it€a€ð ðCatch€22"€fñZ ñoñZ ññ[ ñiñ[ ñr€Many€PñY ñoñY ñersons€withÐ a   ÐMental€Illness?ðð,€Quality€of€Care€2€(Sept.„€Oct.€1993)(Published€by€the€New€York€P&A)Ð Q ÐÌ*¢Stavis£,€Paul€F.,€ð ðThe€Nexus:€A€Modest€Proposal€for€Self„Guardianship€by€Contract:€AÐ 1p  ÐSystem€of€Advance€Directives€and€Surrogate€Committees„at„Large€for€the€IntermittentlyÏMentally€Ill,ðð€16€J.€Contemp.€Health€L.€&€¢Polððy£€(1999)€Ð P  ÐÌStefan,€Susan,€"Silencing€the€Different€Voice:€Competence,€Feminist€Theory€and€Law,"Ï47€U.€Miami€L.€Rev.€763€(1993)ÌÌ*¢Stolle£,€Dennis€P.,€ð ðAdvance€Directives,€AIDS€and€Mental€Health:€¢TJ£€Preventive€Law€forÐ Á Ðthe€HIV„Positive€Client,ðð€4€Psych.,€Pub.€¢Polððy£,€&€L.854€(1998)Ð ±ð ÐÌ*¢Sundram£,€Clarence,€"Informed€Consent€for€Major€Medical€Treatment€of€MentallyÏDisabled€People:€A€New€Approach,"€318€New€Eng.€J.€Med.€1368€(1988)ÌÌ*Swanson,€J.,€¢Tepper£,€M.,€¢Backlar£,€P.,€&€¢Swartz£,€M.,€ð ðPsychiatric€Advance€Directives:Ð a  ÐAn€Alternative€to€Coercive€Treatment?ðð€63€Psychiatry€160€(2000)Ð Q ÐÌ*¢Szasz£,€Thomas,€"The€Psychiatric€Will:€A€New€Mechanism€for€Protecting€Persons€AgainstÏ`Psychosis'€and€Psychiatry,"€37€Am.€Psychologist€762€(1982)ÌÌ*¢Szasz£,€Thomas,€ð ðParity€for€Mental€Illness,€Disparity€for€the€Mental€Patient,ðð€The€Lancet,Ð "@ ÐOctober€10,€1998€p.€1213€(available€at€¢www.cjnetworks.com£/~¢cgrandy£/€articles/Ï¢psych_advance_directive£)ÌÌ*Thomas,€David€L.€&€Watson,€J.€¢Morrissa£,€ð ðAdvance€Directives€in€a€CorrectionalÐ Á%  ÐSetting,ðð€4€Psychology,€Public€Policy,€and€Law€878€(1998)Ô#†X -XXX“/U#ÔÔ‡X“XXX -ÔÐ ±&ð! ÐÌ¢Tomlinson£,€Howe,€¢Natman£€&€¢Rosmuller£,€"An€Empirical€Study€of€Proxy€Consent€forÏElderly€Persons,"€30€Gerontologist€54€(1990).ÌÌWagley,€S.M.,€ð ðAfter€Cruzan:€The€Changing€Art€of€Drafting€Living€Wills€and€DurableÐ a+ #& ÐPowers€of€Attorney,ðð€7€Me.€B.J.€160€(1992)Ð Q,$' ЇWheaten,€L.S.,€ð ðCaring€for€the€Incapacitated„A€Case€for€NonProfit€Surrogate€DecisionÐ Á ÐMakers€in€the€Twenty„First€Century,ðð€64U.Cin.L.Rev.879€(1996)Ð ±ð ÐÌWheaten.€L.S.,€ð ð€Durable€Powers€as€a€Hedge€against€Guardianship:€Should€the€Attorney„Ð ‘ Ð Ðat„€Law€Accept€Appointment€as€Attorney„in„Fact?ðð€2ElderL.J.39€(1994)Ð  À ÐÌ¢Winick£,€Bruce,€"Competency€to€Consent€to€Treatment:€€The€Distinction€Between€AssentÏand€Objection,"€28€Houston€L.€Rev.€15€(1991)ÌÌ*¢Winick£,€Bruce,€"Advance€Directive€Instruments€for€Those€with€Mental€Illness,"€51€U.ÏMiami€L.€Rev.€57€€(1996)€€€ÌÌ¢Zinberg£,€"Decisions€for€the€Dying:€An€Empirical€Study€of€Physicians'€Responses€toÏAdvance€Directive,"€13€¢Vt£.€L.€Rev.€400€(1989)ÌÌÐ  Ñ ÐÌÌà@LL7‚àCASESˆÌÌÓ  Óòò€(Cases€which€implicate€¢ADs£€and€mental€health€treatment€are€marked€with€an€*)óóÐ  À ÐÓ  ÓÌÌòòIn€re:€A.C.óó,€573€A.2d€1235,€1250€(D.C.€1990)€To€determine€the€subjective€desires€of€aÐ Q Ðpatient,€a€court€should€give€the€greatest€weight€to€advance€written€or€oral€directives€inÏorder€to€protect€patient's€right€to€choose.€The€court€reversed€a€trial€court€authorization€forÏa€hospital€to€deliver€the€patientððs€fetus€by€Caesarean€section€without€first€ascertainingÏthrough€substitute€judgment€what€the€patientððs€wishes€would€have€been.ÌÌòò¢Allore£€v.€Flower€Hosp.óó,€1977€WL€362465,€No.€L„96„329€(Ohio€Ct.€App.1997)Ð ñ0  Ð(Unpublished€opinion)€€Summary€judgment€granted€to€defendant€doctor€who€and€hospitalÏwhich€failed€to€honor€an€AD,€when€there€was€no€evidence€that€the€defendants€knew€orÏshould€have€known€of€the€existence€of€the€directive.€Ô#†XK@XXXTï’a#ÔÔ‡XTïXXXK@ÔÐ Á ÐÌòòAnderson€v.€St.€Francis„St.€George€Hospitalóó,€1995€WL€109128€(Ohio€App.€1stÐ ¡à ÐDiv.)(Unpublished)(Ohio€Sup.€Ct.€Rule€2€Applies)(previous€decision€reported€at€83€OhioÏApp.€3d€221,€614€N.E.2d€841€[1992]).€While€both€the€Ohio€durable€power€of€attorney€forÏhealth€care€act€and€the€advance€directive€provisions€provide€immunity€from€civil€liabilityÏfor€following€a€patientððs€advance€directives,€neither€provides€immunity€for€failure€to€followÏthese€directives€in€the€absence€of€an€agreement€to€transfer€a€patient€to€a€provider€willing€toÏfollow€the€directive.€Therefore,€a€patient€is€entitled€to€compensation€for€the€foreseeableÏinjuries€proximately€caused€by€the€unwanted€medical€intervention.€ÌÌòò¢Asselin£€v.€Shawnee€Mission€Medical€Center,€Inc.óó,€894€F.€Supp.€1479€(¢D.Kan£.€1995)Ð !P ÐThere€is€no€private€right€of€action€under€the€Patient€Self„Determination€Act€for€failure€ofÏhospital€to€follow€its€provisions.€ÌÌòòBarber€v.€Superior€Courtóó,€195€Cal.€Rptr.€484,€489€(¢Ct.App£.€1983)€Recognizing€that€lackÐ Ñ$ Ðof€awareness,€procrastination€and€"reluctance€to€contemplate€the€need"€for€ADs€makes€it€aÏtool€which€will€all€too€often€go€unused.Ð  ±&ð! Ð*€òòGuardianship€of€Boyleóó,€674€A.2d€912€(Me.€1996)€Since€the€enactment€of€an€advanceÐ Á Ðdirective€statute,€"[¢t]he£€authority€of€guardians€to€authorize€or€withhold€medical€treatment€isÏnow€limited€only€in€the€case€of€a€ward€who€is€terminally€ill€or€in€a€persistent€vegetativeÏstate€and€has€directed€otherwise€in€a€living€will."€Therefore,€court€authority€is€notÏnecessary€for€a€guardian€to€consent€to€antipsychotic€medication€over€the€objections€of€aÏward,€even€when€the€ward€has€rejected€the€medication€while€competent.ÌÌòòIn€re€Browningóó,€568€S.2d€4€(Fla.€1990)€Enforcing€written€living€will€and€designation€ofÐ Q Ðagent,€"written€declaration€or€designation€of€a€proxy,€in€absence€of€any€evidence€to€theÏcontrary,€establishes€a€¢rebuttable£€presumption€that€constitutes€clear€and€convincingÏevidence€of€the€patient's€wishes."ÌÌ*€òòCohen€v.€¢Bolduc£óó,€455€Mass.€608,€760€N.E.2d€714€(2002).€An€agent€acting€under€aÐ @  Ðvalid,€activated,€unlimited,€generic€health€care€advance€directive€has€the€authority€to€admitÏher€unprotesting€principal€as€a€conditional€voluntary€patient€to€a€mental€health€facility.€TheÏhospital€acted€correctly€when€it€treated€the€principalððs€revocation€of€the€directiveÏ(Massachusetts€allows€revocation€at€any€time,€regardless€of€capacity)€as€a€ð ðthree€dayÐ Á Ðnoticeðð€of€an€intention€to€leave€the€hospital€and€the€timely€filing€of€a€petition€for€civilÐ ±ð Ðcommitment€was€appropriate.€The€Massachusetts€Supreme€Judicial€Courtððs€comprehensiveÏopinion€includes€a€survey€of€state€statutes.€ÌÌòòIn€the€Matter€of€the€Guardianship€and€Protective€Placement€of€Edna€M.F.óó,€210€Wis.2dÐ q° Ð558,€563€N.W.2d€485€(1997);€Case€Note,€14€òòIssues€in€Law€and€Medicine€óó205€(1998).€IfÐ a  Ða€ward€is€not€in€a€persistent€vegetative€state,€it€is€not€in€the€best€interests€of€the€ward€as€aÏmatter€of€law€to€withdraw€life€sustaining€treatment€unless€the€ward€has€executed€anÏadvance€directive€or€other€statement€clearly€indicating€his€or€her€desires.€ÌÌòòFirst€¢HealthCare£€v.€¢Rettinger£óó,€342€N.C.€886,€467€S.E.2d€243€(1996)€The€state€SupremeÐ !P ÐCourt€held€that€the€wife€of€a€nursing€home€resident€must€pay€charges€for€cost€of€medicalÏtreatment€provided€contrary€to€her€objections€and€to€the€husbandððs€living€will€since€theÏrequisite€findings€required€by€the€living€will€statute€were€not€entered€into€the€medical€chartÏprior€to€the€treatment€and€since€the€wife€had€signed€a€contract€agreeing€to€pay€for€the€costsÏof€care.€The€Supreme€Court€reversed€an€opinion€of€the€Appeals€Court.ÌÌòò¢Fiske£€v.€Evangelical€Health€Systemsóó,€674€N.E.2d€888,€221€Ill.€Dec.€95€(1996)€Court€holdsÐ ¡'à" Ðthat€the€defendant€hospital€did€not€have€any€duty€under€the€Illinois€Health€Care€SurrogateÏAct€to€inquire€into€the€availability€of€a€surrogate€absent€a€determination€by€the€attendingÏphysician€that€the€patient€lacked€capacity€and€had€a€qualifying€condition;€the€patientððsÏestate€has€a€private€right€of€action€under€the€Surrogate€Act€but€the€patientððs€familyÏmembers€or€loved€ones€do€not€have€a€private€right€of€action€under€the€Act.Ð Q,$' Їòò¢Gabrynowicz£€v.€¢Heitkamp£óó,€904€F.€Supp.€1061€(¢D.N.D.£€1995)€Case€challenging€provisionÐ Á Ðof€North€Dakota€law€that€limits€the€implementation€of€advance€directives€for€pregnantÏwomen.€Court€acknowledged€that€statute€raised€constitutional€questions,€but€held€it€was€notÏripe€for€adjudication.ÌÌòòEstate€of€Greenspanóó,€137€Ill.2d€1,€558€N.E.2d€1194€(1990)An€agent€may€authorizeÐ q ° Ðwithholding€of€artificial€nutrition€and€hydration€even€through€living€will€statute€does€notÏallow€such€use€of€a€living€will.ÌÌòòIn€re:€¢Gordy£óó,€658€A.2d€613€(Del.€Chancery€Ct.,€1994)€A€guardian€was€appointed€for€a€96„Ð 1p  Ðyear„old€woman€with€Alzheimer's€disease€who€was€not€mentally€incapacitated€and€who€hadÏrefused€a€gastric€feeding€tube€and€had€so€stated€in€a€1990€living€will.€The€guardian€wasÏinstructed€to€follow€the€woman's€expressed€direction€regarding€gastric€feeding.€ÌÌ*€òò¢Hargrave£€v.€Vermontóó,€No.€2:99„CV„128,€¢U.S.D.C.£€¢Vt£.,€(October€11,€2001)€appeal€toÐ á  ÐSecond€Circuit€filed€February€2002.€Vermont€Act€114€is€facially€discriminatory€againstÏpeople€with€mental€illness€under€the€ADA€and€ðð€504€insofar€as€it€allows€their€lawfullyÏexecuted€¢DPOAs£€to€be€abrogated€when€they€have€been€determined€to€be€in€need€of€careÏand€treatment,€since€no€such€provision€subjects€non„mentally€ill€individuals€to€suchÏabrogation,€even€when€honoring€the€¢DPOA£€might€result€in€death.€ÌÌòò*In€re€Janet€S.óó,€712€N.E.2d€422€(Ill.€App.€1999)€Failure€of€state€to€allege€that€it€had€madeÐ q° Ða€good€faith€effort€to€determine€whether€the€patient€had€executed€an€advance€directive€wasÏjurisdictional€in€nature€and€reversible€error.€(òòContraóó,€òòIn€re€Len€P.óó,€òòinfraóó.)Ð Q ÐÌ*€òò¢Khiem£€v.€United€Statesóó,€612€A.2d€160€(DC€1992)€A€murder€defendant,€foundÐ 1p Ðincompetent€to€stand€trial,€appealed€from€an€order€directing€that€he€be€treated€withÏantipsychotic€medication€to€restore€his€competence.€Among€other€arguments,€the€defendantÏclaimed€that€such€treatment€would€violate€his€rights€under€the€Health€Care€Decisions€Act.ÏThe€Court€held€that€the€¢HCDA£€has€no€applicability€to€a€dispute€between€an€incompetentÏpretrial€detainee€and€a€prosecutor€attempting€to€enforce€the€governmentððs€law€enforcementÏinterest€in€bringing€an€accused€to€trial.€¢Khiem£€did€not€have€a€written€advance€directive.ÌÌ*òòIn€re€Len€P.óó,€706€N.E.2d€104€(Ill.€App.€1999)€The€stateððs€failure€to€allege€in€a€petitionÐ ±&ð! Ðfor€involuntary€administration€of€antipsychotic€medication€that€it€had€made€a€good€faithÏeffort€to€determine€whether€the€patient€had€executed€an€advance€directive€was€not€groundÏfor€reversal,€but€order€reversed€on€other€grounds.€(òòContra,€óóòòIn€re€Janet€S.óó,€òòsupra.)óóÐ )À!$ ÐÌòòGuardianship€of€Masonóó,€41€Mass.€App.€Ct.€298,€669€N.E.2d€1081€(1996)A€case€in€whichÐ a+ #& Ða€designated€agent€refused€to€consent€to€a€"no„code"€order.€The€appellate€court€upheld€theÐ Q,$' Ðappointment€of€a€guardian€to€supersede€the€agent's€authority,€holding€that€suchÏappointment€was€warranted€when€agent€was€not€acting€in€accordance€with€standards€ofÏHealth€Care€Proxy€Act.€ÌÌòò¢Osgood£€v.€¢Genesys£€Regional€Medical€Centeróó,€€(Cir.€Ct.,€¢Genesee£€¢Cty£.,€Michigan)(March€Ð  À Ð1997)€Choice€in€Dying€reports€that€a€Michigan€Circuit€Court€held€that€a€hospitalÏcommitted€a€battery€when€it€misrepresented€procedures€performed€in€contravention€of€aÏdurable€power€of€attorney€for€health€care.€A€jury€awarded€$16€million€for€emotionalÏanguish€and€medical€expenses.€The€parties€reportedly€settled€and€have€not€appealed.€ÌÌòòIn€re€O'Connoróó,€534€¢N.Y.S.£€2d€886,€892,€72€N.Y.2d€517,€531,€531€N.E.2d€607,€613Ð !`  Ð(N.Y.€1988)The€existence€of€written€document€suggests€author's€seriousness€of€purpose€inÏmaking€health€care€decisions.ÌÌòòIn€re€Peteróó,€529€A.2d€419€(N.J.€1987)€A€durable€power€of€attorney€drafted€specifically€forÐ á  Ðhealth€care€decisions€should€be€honored€even€though€NJ€statute€does€not€specificallyÏauthorize€such€powers.ÌÌòòPocono€Medical€Center€v.€Harleyóó,€11€Fiduc.€Rep.€2d€128€(C.P.€Monroe€¢Cnty£,€Penn.Ð ¡à Ð1990)€Court€enforces€€an€oral€directive€over€a€written€power€of€attorney€which€was€notÏdurable€and€did€not€mention€health€care.ÌÌ*òòRichter€v.€Vermont€State€Hospitalóó,€(Washington€¢Cnty£.€Sup.€Ct.,€filed€July€17,1997)€TheÐ a  Ðcomplaint€alleges€that€the€defendants€failed€to€recognize€and€comply€with€the€plaintiffððsÏAD.€It€is€also€alleged€that€the€hospital€retaliated€against€the€plaintiff€by€restricting€hisÏvisitors.€(Filed€by€Vermont€P&A.)(Pleadings€available€from€NAPAS€receptionist.)ÌÌÔ#†XKsXXX“Ûj#ÔÔ‡Xxf XXXKsÔòòIn€the€Matter€of€¢Rena£òòóó,€óó46€Mass.€App.€335€(1999)€A€seventeen€year€old€patient,€a€JehovahððsÐ !P ÐWitness,€refused€a€blood€transfusion€after€she€lacerated€her€spleen€in€a€¢snowboarding£€accident.ÏShe€had€executed€a€written€advance€directive€declaring€that€she€will€not€assent€to€a€bloodÏtransfusion.Ô#†XKsX XXxfC#ÔÔ‡X“XXXKsÔ€Ô#†XKsXXX“Í#ÔÔ‡Xxf XXXKsÔThe€Appeals€Court€held€that€the€trial€court€had€erred€by€not€taking€into€accountÐ Õ# Ðthe€childððs€maturity€in€determining€her€best€interests.€The€Court€held€that€the€trial€court€shouldÏthen€have€balanced€her€best€interests,€the€rights€of€her€parents€(who€also€opposed€theÏtreatment),€and€the€stateððs€interests.Ô#†XKsX XXxf‘#ÔÔ‡X“XXXKsÔ€The€Advance€Directive,€however,€apparently€was€notÐ &Ü! Ðconsidered€controlling.€ÌÌòòIn€re€¢Roche£óó,€296€¢N.J.Super£€583,€687€A.2d€349€(N.J.€Super.€Ct.€Ch.€Div.€1996)€€AnÐ m)¬!$ Ðadvance€medical€directive€executed€by€a€woman€who€has€been€adjudicated€incompetent€wasÏnot€legally€binding€on€health€care€providers,€but€could€be€considered€by€guardian€asÏevidence€of€wardððs€subjective€intent.€The€court€reasoned€that€notwithstanding€the€opinionÐ =,|$' Ðof€her€public€guardian€and€a€doctor€that€the€ward€clearly€understood€the€nature€and€effectÏof€the€AD,€and€even€though€in€NJ€€an€incompetent€person€may€revoke€and€reinstate€anÏAD,€the€legislature€had€intended€that€only€competent€persons€may€execute€an€AD.ÌÌ*òòMatter€of€Rosa€M.óó,€155€Misc.€2d€103,€597€¢N.Y.S.£€2d€544€(Sup.€Ct.€1991)Court€refusesÐ Q Ðto€order€ECT€for€an€incompetent€woman€with€previously€written€statement€refusingÏtreatment,€even€though€the€statement€does€not€comply€with€statutory€standards.ÌÌòòIn€re€Rosebushóó,€195€Mich.€App.€675,€491€N.W.2d€633€(1992)€Previously€expressedÐ P  Ðwishes€of€a€mature€minor€should€be€taken€into€consideration€in€determining€substitutedÏjudgment.€ÌÌ*òò¢Shambaugh£€v.€¢Wolk£óó,€302€N.J.€Super.€380,€695A.2d€82€(Super.€Ct,€Chancery€Div.,Ð Ñ Ð1996)€This€case€is€€a€suit€by€a€stepdaughter€against€her€stepfather€to€force€him€to€allow€herÏto€visit€her€mother€in€a€mental€hospital€and€later€a€nursing€home.€The€stepfather€defendsÏhis€action,€in€part,€by€claiming€that€he€had€the€authority€to€regulate€visits€as€the€motherððsÏagent€under€a€power€of€attorney€which€includes€€health€care€decisions.€After€finding€it€hadÏjurisdiction€to€decide€the€claim,€the€court€denied€cross€motions€for€summary€judgmentÏnoting€that€there€was€a€genuine€issue€of€material€fact€as€to€what€the€motherððs€wishes€were.ÏThe€court€noted€that€her€wishes€are€material€since€the€attending€physician€had€not€certifiedÏher€to€be€incapable€under€the€AD€statute€and,€besides,€that€her€AD€did€not€expressly€orÏimplicitly€give€the€agent€the€right€to€make€visitation€decisions.ÌÌòò¢Werth£€v.€Tayloróó,€190€Mich.€App.€141,€475€N.W.2d€426€(1991)€Patients'€prior€competentÐ ! ` Ðrefusal€of€treatment€need€not€be€respected€in€an€emergency€because€it€did€not€specificallyÏanticipate€that€refused€treatment€might€be€necessary€to€save€patient's€life.ÌÌòòGuardianship€of€¢Whalen£óó,€Mass.€App.€Ct.€95„J„535€(1995)€(unpublished)€The€CourtÐ á#  Ðdetermined€that€there€are€no€statutory€limits€on€the€subject€matter€of€a€durable€power€ofÏattorney€and,€therefore,€it€may€include€authorization€for€the€attorney„in„fact€to€make€healthÏcare€decisions.€The€durable€power€may€stand€on€its€own€or€be€used€in€tandem€with€a€healthÏcare€proxy.€ÌÌÌÌÐ a+ #& ЇÌÌÌÌÌÌÌÌÌÔ#†XKsXXX“6’#Ô