Psychiatric advance directives (Ulysses Contract): the need for a specific law and a criteria proposal for its introduction

Summary. Aim. Advance healthcare directives in the psychiatric field raise more concerns and controver sies compared to their use in other medical branch es. We discuss the role of advance directives in this field and suggest a criteria proposal for the settle ment of a comprehensive regulation on the matter. Methods. We analyse the existing law and discuss the ethical points in the Italian context and, in com parison, with the United Kingdom context. Results. Numerous studies have highlighted that psychiatric patients experience advance directives as an instru ment to participate in therapeutic decision-making. Regarding the usefulness of advance directives, Italy and the United Kingdom did not approve deonto logical rules or laws. The United Nations Commission states that, based on the principles of the Convention on the Rights of Persons with Disabilities, it is neces sary to respect the spatient’s will, even if it is biased by psychic disorders. Conclusions. The Convention does not consider advance directives; instead, they just suggest using some support to have the patient regain their competence. In case this is unsuccessful, it is necessary to appoint a substitute decision-maker to express, even in the light of the advance direc tives, the will that the patient would have expressed if he had been competent.