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Advance Directive For Mental Health

How Mental Health Proxies Make Decisions

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There are two alternative guides for proxies to make mental health decisions for a mentally incompetent person:

  • “Substituted judgment”: Substituted judgment is the proxy makes a decision based on what the proxy thinks the principal (the incompetent person) would have wanted. The proxy gets this information from the document appointing the proxy if it is included. The proxy also gets this information from discussions with the principal.
  • “Best interest”: Best interest judgment is when the proxy makes a decision on what he or she thinks is the best interest of the mentally incompetent person. This may lead to decisions which the now mentally incompetent person would not have wanted. (Some state laws require the “best interest” test when making a decision despite the wishes of the person who executed the document.)

The laws generally require that health care providers follow the proxy’s instructions when acting under an Advance Directive for Mental Health.

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