LINCOLN — Nebraskans now have a couple of legal options to determine the treatment they want — or don’t want — when they can’t speak for themselves.
They can make out a living will or name someone as their health care power of attorney, giving them the ability to make decisions about their care.
On Friday, lawmakers considered a new kind of legal document, one aimed at allowing people with mental illnesses to spell out what treatment they want if they become too sick to make competent decisions.
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State Sen. Kate Bolz of Lincoln said the documents, called advance mental health care directives, can increase patient choice and self-determination. They also can help people avoid involuntary commitment or jail.
“Fundamentally, this is about giving individuals choices and options to take care of themselves when they are sick,” she told members of the Judiciary Committee.
Bolz, who introduced Legislative Bill 247, said advance mental health care directives, also called psychiatric advance directives, were first introduced in the 1980s and are legally recognized in 30 states.
She offered an example of a person diagnosed with depression who periodically goes through times when the illness worsens.
From past experience, the person may know that he or she refuses medications during those times. He or she also may know that certain types of medications do not work or have intolerable side effects.
Through an advance mental health care directive, the person could instruct health care professionals to give him or her medications and could let them know which ones should be avoided. The person could also designate someone to make treatment decisions during those extreme downtimes.
“This is a proactive set of directions,” Bolz said.
The idea won support from NAMI Nebraska, a group supporting families and friends of people with mental illness; Community Alliance, which provides services for people with mental illness; and the Douglas and Lancaster County Boards.
Jacob Dahlke, the ethics director at Nebraska Medicine, also backed the bill. He compared the idea to “The Odyssey,” the epic poem in which Ulysses orders his men to tie him to the mast of his ship and put beeswax in their ears so they would ignore his pleas while sailing past the island of the Sirens, whose song reputedly lured men to their death.
But Brad Meurrens of Disability Rights Nebraska argued against the bill. He said the measure was confusing and did not include enough treatment alternatives.
He raised concerns in particular about when people would be allowed to change their minds about treatment. LB 247 allows for self-binding directives, under which refusal of treatment would be considered evidence that the person should get treatment.
Meurrens urged lawmakers to take more time to study and involve more people who have been through the mental health system in improving the bill.
“We would like to see psychiatric advance directives in place in Nebraska,” he said. “We just believe that this bill is not the vehicle at this time and issues need to be addressed in a broader discussion with a wider array of stakeholders.”
