- 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.
Nevada Q and A
Ten commonly asked questions about PAD’s for Nevada
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 February 2020.
1. Can I write a legally-binding psychiatric advance directive (PAD)?
Yes, the Nevada statutes allow you to make a written declaration of instructions, information and preferences regarding your psychiatric care. Psychiatric care may not be administered without your express and informed consent or, if you are incapable of giving informed consent, the express and informed consent of your legally responsible person (agent) named pursuant to a valid durable power of attorney for health care or your consent expressed in the advance directive for psychiatric care.
2. Can I write advance instructions regarding psychiatric medications and/or hospitalization?
The Nevada statutes allows you to write advance instructions for psychoactive medications and specify administration of which medications you explicitly consent or do not consent to. You can also describe in writing instructions regarding admission to and retention in a medical facility for psychiatric care. You can consent to or decline admission to a medical facility for psychiatric care. You can also specify the maximum number for days for which you consent to be admitted to a medical facility for psychiatric care. Additionally, you can specify in writing preferences for a medical facility.
3. Does anyone have to approve my advance instructions at the time I make them?
No. However, your form must be attested by two witnesses, who are personally known to you and who are present when you sign the advance directive. The two witnesses must declare that you appear to be of sound mind and not under duress, fraud, or undue influence. Neither of the witnesses may be:
(a) The attending physician or provider of health care;
(b) An employee of the attending physician or provider of health care;
(c) An owner or operator of a medical facility in which the principal is a patient or resident or an employer of such an owner or operator; or
(d) A person appointed as an attorney-in-fact by the advance directive.
The form must be certified by notary public. The notary public affirms that you willingly and voluntarily made and executed advance directives and certifies sworn statement of the witnesses.
4. Can I appoint an agent to make mental health decisions for me if I become incompetent?
Yes. You may appoint a person as your agent to make treatment decisions for you if you become incapable.
5. If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization?
Your agent may consent or refuse medications on your behalf if you become incapable to make treatment decisions. Your agent may not consent on your behalf to (1) your commitment or placement in a mental health treatment facility; (2) electroconvulsive therapy (ECT); (3) psychosurgery; (4) sterilization; (5) abortion; or (6) aversive interventions. Also, your agent may not consent to any treatment that you have explicitly refused in your written instructions.
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 does not say how your agent must act with regard to non life-sustaining procedures. However, the more you discuss and document your wishes in conjunction with them, the more likely it is that those wishes will be followed.
7. Is there any rule that says that I can only make advanced instructions, only appoint an agent, or that I must do both?
No. You can limit advance directives to written instructions, or only appoint an agent to make treatment decisions on your behalf, or do both.
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 instructions you include in advance directives will be followed if two providers of health care determine that you are incapable of making or communicating treatment decisions, one of whom must be a physician or licensed psychologist and the other of whom must be a physician, a licensed psychologist, a psychiatrist or an advance practice registered nurse who has the psychiatric training and experience as defined in Nevada Revised Statutes.
9. Does the statute say anything about when my mental health providers may decline to follow my PAD?
Yes. Mental health providers may decline to follow your advance directives if
(a) Compliance, in the opinion of the attending physician or other provider, is not consistent with generally accepted standards of care for the provision of psychiatric care for your benefit;
(b) Compliance is not consistent with the availability of psychiatric care requested;
(c) Compliance is not consistent with applicable law;
(d) You are admitted to a mental health facility or hospital pursuant to certain sections of the Nevada Revised Statutes that regulate the process of involuntary commitment to inpatient psychiatric facility, and a course of treatment is required pursuant to those provisions; or
(e) Compliance, in the opinion of the attending physician or other provider, is not consistent with appropriate psychiatric care in case of an emergency endangering your life or health, or the life or health of another person.
In the event that one part of the advance directive is unable to be followed, all other parts of the advance directive must be followed.
10. How long does my PAD remain valid?
An advance directive becomes effective upon its proper execution and remains valid for a period of 2 years after the date of its execution unless revoked. You may revoke an advance directive for psychiatric care at any time and in any manner, as long as you are capable of making such a decision. You may exercise this right of revocation in any manner by which you are able to communicate an intent to revoke and by notifying your physician or other provider of health care of the revocation.
You may not revoke advance directives when you are found incapable by two providers of health care, one of whom must be a physician or licensed psychologist and the other of whom must be a physician, a licensed psychologist, a psychiatrist or an advance practice registered nurse who has the psychiatric training and experience as defined in Nevada Revised Statutes.