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Int J Law Psychiatry. 2012 Jan-Feb;35(1):11-8. doi: 10.1016/j.ijlp.2011.11.001. Epub 2011 Dec 3.

Choosing to limit choice: Self-binding directives in Dutch mental health care.

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  • 1Maastricht University, CAPHRI School for Public Health and Primary Care, Dept. of Health, Ethics & Society/Metamedica, Maastricht, The Netherlands.


In certain cases of chronic mental illness (for example bipolar disorder) a self-binding directive or Ulysses contract may be a helpful intervention to prevent harm to the person him- or herself and/or others. By choosing such an arrangement, the patient can indicate when and how mental health professionals may intervene against his or her will and provide indicated care which may lead to an improvement of the patient's mental condition. In the Netherlands, since 2008 the Compulsory Admissions Act has been amended and now includes a paragraph on self-binding. Starting from the Dutch debate and statutory regulation of self-binding in mental health care, a number of issues with broader relevance are discussed, particularly as these pertain to the legal regulation and juridification of self-binding. It is argued that too many detailed rules are a threat to increasing patient empowerment.

Copyright © 2011 Elsevier Ltd. All rights reserved.

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