Although each PAD will be unique in terms of an individual’s preferences, these documents don’t need to be complicated, says Dr. Duckworth. Here are the essential elements to keep in mind.
Gather Information
Put together all of the info that you would want considered if you’re incapacitated, including medications and treatment locations. Be specific about why you’re making these choices, suggests Swartz. For example, you might note that a certain drug gives you severe side effects and list what those have been in the past.
“Keep in mind that what you put in a PAD is a preference, not an entitlement,” he says. “Your wishes should be realistic, with the understanding that these decisions still have to be filtered through what’s available and what a clinician may recommend.”
Name a Proxy
Choose a person you trust and who knows you well enough that if an unexpected decision comes up, that proxy will have a good grasp of what you would want, says Swartz. There are some limitations here, he adds. For example, many states stipulate that you cannot appoint a treatment provider like a psychiatrist or other doctor as your healthcare proxy.
Distill the Info
Although there may be a great deal you’d like to include, it’s better to have the information be simple and easy to read quickly, says Anna Costakis, MD, director of psychiatry residency training at Northwell Health’s Staten Island University Hospital in New York.
In fact, a guide from the Substance Abuse and Mental Health Services Administration includes a printable wallet-sized card with spots to list hospital and treatment preferences, emergency contacts, and what you’d like done in a crisis situation.
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This is a condensed version of a longer document that provides more details, but even that should be as brief as possible, suggests Dr. Costakis.
“There are forms of the PAD that are on apps and easily kept with the person at all times, but in general, this should be like an insurance card that you can access even when you’re in crisis,” she says.
Legal Requirements
It’s important to understand that a PAD is not recognized in every state, according to Anne Raish, senior staff attorney at the Judge David L. Bazelon Center for Mental Health Law in Washington, DC.
“Roughly half of states have a specific provision for PADs,” she says. “However, even in states where there’s no provision, you can use a medical directive to specify psychiatric decisions. It’s helpful to consult an attorney when drafting one, but if that’s not possible, at the very least you need to have the document witnessed and notarized.”
Distribute Copies
Similar to a will or any other legal document, your PAD won’t do much good if it’s sitting in a drawer and no one knows it’s there, says Raish.
“This should be treated like any other binding legal document,” she says. “You need to give copies to whomever will need to have it when you’re in crisis.” That includes the named proxy, as well as your mental health provider, attorney, and any friends or family members who may be involved in your care.