Zelle Heather, Kemp Kathleen, Bonnie Richard J
Dr. Zelle and Mr. Bonnie are with the University of Virginia School of Law, Charlottesville (e-mail:
Psychiatr Serv. 2015 Jan 1;66(1):7-9. doi: 10.1176/appi.ps.201400435.
Virginia appears to be the first state to commit itself to statewide implementation of psychiatric advance directives, and its experience may be highly instructive for other states. The project began with consensus building among stakeholders (2007-2009), followed by revisions to Virginia's Health Care Decisions Act (2009-2010) and designation of five of the state's 40 Community Services Boards as demonstration sites for facilitation efforts. Early implementation efforts quickly showed that psychiatric advance directives are not self-executing innovations. This column describes the early policy and practice innovations, lessons learned from initial implementation efforts, and three approaches to facilitating completion of advance directives by consumers.
弗吉尼亚州似乎是首个致力于在全州范围内实施精神科预嘱的州，其经验可能对其他州具有很高的指导意义。该项目始于利益相关者之间的共识构建（2007 - 2009年），随后对弗吉尼亚州的《医疗保健决策法案》进行了修订（2009 - 2010年），并指定该州40个社区服务委员会中的5个作为促进工作的示范站点。早期的实施工作很快表明，精神科预嘱并非自行生效的创新举措。本专栏描述了早期的政策和实践创新、从初步实施工作中吸取的经验教训，以及促进消费者完成预嘱的三种方法。
