- A psychiatric advance directive (PAD) is a legal document that documents a person’s preferences for future mental health treatment, and allows appointment of a health proxy to interpret those preferences during a crisis.
- PADs may be drafted when a person is well enough to consider preferences for future mental health treatment.
- PADs are used when a person becomes unable to make decisions during a mental health crisis.
Georgia Q and A
Ten commonly asked questions about PAD’s for Georgia
Please note: the following 10 FAQs are designed to provide a quick and accessible guide to what your state’s Statutes say – or do not say – about PADs. The FAQs do not attempt to provide a complete picture of the law in your state, nor can they take the place of legal advice. The answers were accurate when written in September 2013.
1. Can I write a legally-binding psychiatric advance directive (PAD)?
Yes, by appointing an agent. Georgia’s Advance Directive for Health Care Act allows you to appoint a health care agent to make health care decisions for you if you become incompetent to make those decisions yourself, with certain exceptions (see question 4 below). Health care decisions may include decisions about mental health. Although not mandatory, it is highly recommended that you use Georgia’s statutory short form Advance Directive for Health Care to appoint your agent.
2. Can I write advance instructions regarding psychiatric medications and/or hospitalization?
The Georgia statutes do not allow you to write advance instructions for your psychiatric care in a freestanding document. However, if you appoint an agent, you may wish to specify how you would like that person to make decisions for you. If there are particular matters that you wish your agent to make clear to your treating physicians, it is advisable to discuss them with your agent and document them clearly in part 2 of the statutory short form Advance Directive for Health Care.
3. Does anyone have to approve my advance instructions at the time I make them?
No. However, your form must be signed by two adult witnesses, of “sound mind”, who must declare that you were of “sound mind” and not under duress when you created the document. You must be present during the signature of both witnesses. Neither witness may be your health care agent, directily involved in your health care, or knowingly in line to inherit anything or benefit from your death. Only one of the two witnesses may be an employee of the health care facility where you are receiving treatment. If you are a “patient in a hospital or skilled nursing facility” at the time you create the document, it must also be signed by your attending physician.
4. Can I appoint an agent to make mental health decisions for me if I become incompetent?
Yes, as outlined above. Your health care agent may not be a physician or health care provider directly involved in your care. Note that your agent may not consent to psychosurgery or sterilization on your behalf. Furthermore, your agent may not consent to involuntary hospitalization otherwise covered by Georgia’s involuntary treatment laws.
5. If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization?
Yes. The general rule is that your agent may consent or refuse any medical treatments or procedures on your behalf when you are incompetent to make decisions yourself. However, you may choose to limit your agent’s authority in part 2 of the statutory short form Advance Directive for Health Care as indicated there: for example, you may wish to decline electroconvulsive therapy (ECT) in all circumstances.
6. Does my agent have to make decisions as he/she thinks I would make them (known as “substituted judgment”), or does he/she have to make them in my “best interests”?
The statute says that the agent must not make a decision contrary to any decision you made when you remained competent. This amounts to a substituted judgment standard. It is important to make your wishes known to your agent when you create your PAD.
7. Is there any rule that says that I can only make advanced instructions, only appoint an agent, or that I must do both?
Yes. As explained above, it is not possible to write advance instructions only. If you wish to create a PAD, you must appoint an agent, but the extent to which you also document your decisions is up to you.
8. Before following my PAD, would my mental health care providers need a court to determine I am not competent to make a certain decision?
No. The statute states that the provider’s obligation to consult the agent begins “whenever…[he/she] believes a patient is unable to understand the general nature of the health care procedure which the provider deems necessary”.
9. Does the statute say anything about when my mental health providers may decline to follow my PAD?
No. However, it is important to note that mental health care providers might legally decline your agent’s instructions if you were considered a danger to yourself or others, or otherwise in an emergency.
10. How long does my PAD remain valid?
Your Advance Directive for Health Care is valid until revoked. You may revoke it at any time, orally or in writing. If you choose to revoke your directive orally, you must do so in the presence of an adult witness who confirms it in writing within 30 days. You may also revoke your advance directive by completing a new one or destroying the existing one. If you marry after creating an Advance Directive for Health Care it will revoke any health care agent other than your spouse. If you appoint your spouse as your agent and subsequently become divorced, the designation of your spouse as your health care agent will be revoked.