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LETTERS: Thomas Szasz You don't in psychiatry BMJ 2007; 335: 900 [Full text]

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Advance Decisions

Robert H Keys   (16 November 2007)

You don't in psychiatry

Thomas Szasz   (17 November 2007)

Dr. Szasz is Right on Psychiatric Wills

Keith Hoeller   (19 November 2007)

Advance Decisions 16 November 2007
Robert H Keys, Mental Health Act Manager Mascalls Park, Mascalls Lane, Brentwood, CM14 5HQ Send response to journal: Re: Advance Decisions	The letter from Thomas Szasz on advance decisions in psychiatry ought not to go unchallenged. Szasz asserts that advance decisions will have no effect for mental health patients and cannot do so '... as long as we have special laws for such patients.'Only someone with an anti-organised psychiatry agenda would adopt such an exagerated stance. Whilst it is true that a valid advance decision to refuse treatment for mental disorder could be over-riden by the Mental Health Act, a patient would have to be detained first and far from all patients meet the criteria for detention at any time. If the advance decision related to a medical procedure it could not be so over-riden and would remain in force, thus protecting the autonomy of mental health patients and their right to plan ahead and control their own lives. Competing interests: None declared
You don't in psychiatry 17 November 2007
Thomas Szasz, Professor of psychiatry emeritus, State University of New York, Upstate Medical University, Syracuse Home. 4739 Limberlost Lane, Manlius, NY 13104 Send response to journal: Re: You don't in psychiatry	Robert H. Keys acknowledges, “Whilst it is true that a valid advance decision to refuse treatment for mental disorder could be over-riden [sic] by the Mental Health Act,” yet objects to my pointing it out. I continue to believe physicians have a responsibility to tell patients the truth about their medical-legal situation. Thomas Szasz, M.D. Competing interests: None declared
Dr. Szasz is Right on Psychiatric Wills 19 November 2007
Keith Hoeller, Editor Review of Existential Psychology & Psychiatry, Seattle, WA 98105 Send response to journal: Re: Dr. Szasz is Right on Psychiatric Wills	Editor: Dr. Thomas Szasz knows what he is talking about and deserves better than to have his ideas dismissed with a label ("anti-psychiatry') that he has explicitly rejected. He is the inventor of the mental health advanced directive or psychiatric will ("The Psychiatric Will: A New Mechanism for Protecting Persons Against 'Psychosis' and Psychiatry," American Psychologist 37 (July, 1982), pp. 762-770. Szasz's intention, as always, was to empower and liberate psychiatric patients, that is, American citizens, by giving them the choice of deciding whether or not to accept psychiatric "treatment." However, psychiatrists--and the families of the so-called "mentally ill"--have completely perverted his idea for the purpose of depriving people of the legal right to refuse psychiatric treatment, as always. Even an advance directive that allows the person to refuse any future psychiatric treatment is deceptive precisely because state involuntary treatment acts will take precedence over any such directive. The hallowed ethical principle of "informed consent" should require all such directives to read as follows: "You have the right to accept psychiatric treatment that you do not want; you do not have the right to refuse any treatment that you do not want." Sincerely, Keith Hoeller, Ph.D. Editor, Review of Existential Psychology & Psychiatry Seattle, WA 98105 Competing interests: None declared