Service Users
- The Form - Please Note: Before filling in the form, you should read the legal information
- Legal Information
- What doctors will do and what they should do
- Diminished competence
- More information
People with mental illness who may become severely unwell in the future can make an advance directive to say:
1. the treatment they would like; and
2. any treatments they don’t want, If they become too unwell to make those decisions.
The Mental Health Commission recommends that people with an ongoing illness consider making an advance directive, using the FORM for an Advance Directive on this website.
We recommend that you discuss your treatment choices with your family/whānau and doctor, so that they understand what you want, and why. Families may feel they are in a difficult position if they find out when treatment they disagree with is being provided. Health providers may also feel they are put in a difficult position if this occurs.
We also recommend that you get a doctor to sign your advance directive to say that you are competent to make the decisions you mare making. That will increase the chance of you getting the treatment you want.
What doctors will do and what they should do
If you are under the Mental Health (Compulsory Assessment and Treatment) Act 1992 (MH Act), doctors can override your advance directive. Just because they insist that you take one type of medication, does not mean you are incompetent to make other decisions about your health care. Even if you are under the MH Act, doctors should still try to get your agreement to treatment, as they should at any other time.
We recommend that you make an advance directive even if you may be placed under the MH Act in future. At the very least, your advance directive will tell others what treatment you prefer.
If you are not under the Mental Health Act, doctors should follow your advance directive unless they have good evidence of at least one of the following conditions:
- You were not competent when you made your advance directive.
- You did not have enough information to make decisions about your treatment.
- The treatment you consented to is not useful ("clinically indicated") for treating your condition.
- The treatment you refused is the only good treatment for you, if you are a danger to yourself or others.
- The treatment you want is not provided by the public health system.
- You did not make the advance directive of your own free will.
- You did not intend your advance directive to be used in this situation.
- Your advance directive has expired.
Note that this has not yet been tested in the New Zealand courts.
If a doctor does not follow your advance directive, ask them to explain their decision, in person and in writing. If you are unhappy with the explanation, you can complain to the Health and Disability Commissioner.
Diminished competence
Depending on the nature of the health-care choice, diminished competency will not necessarily invalidate an advance directive. Certain choices may still be valid.
Example
An advance directive might instruct future providers not to administer any medication to a service user, or it might refuse to allow students to be present during any procedure. While it might be shown later that the service user was not competent at the time to make decisions regarding medication, he or she might still have been competent to make decisions about participating in teaching programmes. Right 7(3) of the Health and Disability Code states:
"Where a consumer has diminished competence, that consumer retains the right to make informed choices and give informed consent, to the extent appropriate to his or her level of competence."
More Information
The Mental Health Commission and the Health and Disability Commission have a pamphlet ‘Advance directives in mental health care and treatment: Information for mental health service users’. To download the document click here or go to or www.hdc.govt.nz, or you can get a copy from the Mental Health Commission.
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