Whose voice is heard? Mental health professionals’ involvement, epistemic injustice, and the ethics of psychiatric advance directives
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By
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March 18, 2026
Objective:
To analyze the role of mental health professionals in facilitating psychiatric advance directives (PADs) while addressing specific ethical challenges and epistemic injustices faced by women with mental health conditions.
Key Findings:
- Women with mental health conditions face coercive practices and epistemic injustice, impacting their autonomy and decision-making.
- While PADs can promote autonomy, their implementation is inconsistent and often lacks adequate support, necessitating systemic changes.
- Mental health professionals play a crucial role in the drafting of PADs, which can either empower or constrain patients' epistemic agency, highlighting the need for ethical training.
Interpretation:
Ethically sensitive facilitation of PADs can transform them into spaces of epistemic repair, ensuring respect for women's autonomy and lived experiences, while addressing systemic inequities.
Limitations:
- Limited empirical research on the impact of clinician-mediated drafting on patients' epistemic agency, which may skew understanding of PAD effectiveness.
- The review focuses primarily on women's experiences, which may not encompass all affected populations, potentially overlooking intersectional issues.
Conclusion:
Mental health professionals, especially nurses, must be trained and supported to act as agents of ethical and epistemic justice in the facilitation of PADs, emphasizing the need for interdisciplinary collaboration.
