- 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.
Oklahoma Q and A
Ten commonly asked questions about PAD’s for Oklahoma
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 October 2013.
1. Can I write a legally-binding psychiatric advance directive (PAD)?
Yes. Oklahoma’s Advance Directives for Mental Health Treatment Act allows you to write instructions (a “declaration”) for your psychiatric treatment in the event that you are incapable to make or communicate those instructions. The statute also allows you to appoint an agent, known as an “attorney in fact”, to instruct mental health care professionals for you. You may choose to make a declaration, appoint an attorney in fact, or do both. Although there is no mandatory form provided your document is in writing and is signed in the correct way (see question 3), a suggested form is available here.
2. Can I write advance instructions regarding psychiatric medications and/or hospitalization?
Yes. You may use your declaration to express any and all wishes you have about medications and electroconvulsive therapy (ECT), including refusals of either. You may also consent to future treatment in a psychiatric facility for a period of up to 28 days.
3. Does anyone have to approve my advance instructions at the time I make them?
No. However, your document must be signed by two adult witnesses.
4. Can I appoint an agent to make mental health decisions for me if I become incompetent?
Yes. You may name as your attorney in fact any capable adult who personally knows you. The exception is that an employee or owner of your mental health care provider or facility may not act as your agent.
5. If I become incompetent, can my agent make decisions for me about medications, and/or hospitalization?
Yes. If you become incompetent, your attorney in fact is empowered to make all decisions that you could have made if you were competent. If you wish your attorney in fact to consent on your behalf to inpatient treatment, you must make this clear on your form in advance so that your agent will have that authority.
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”?
Your attorney in fact must use substituted judgment by following any declaration you have made and by following any wishes of yours which he/she otherwise knows. If your wishes are not known, your attorney in fact must act in your best interests.
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 may do one, the other, or 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. Your document takes effect when two mental health professionals evaluate you and declare that you are not competent to make your own treatment decisions at that time.
9. Does the statute say anything about when my mental health providers may decline to follow my PAD?
Yes. Your providers may decline to follow your document if it is contrary to a court order (including an order for involuntary treatment under Oklahoma law). It’s important to note that the instructions of your mental health declaration may be superseded by the instructions of an advance directive for health care or durable power of attorney, if you have either and if they conflict.
10. How long does my PAD remain valid?
Your document remains valid until you revoke it or create a new one. You may revoke your document at any time in one of four ways: (1) by destroying it, or having it be destroyed in your presence; (2) by a written, signed revocation; (3) by unambiguously saying you wish to revoke it, in the presence of two adult witnesses; (4) by unambiguously expressing your wish to revoke it to your attending physician or psychologist.