In discussions about our recent research in advance directives in mental health a number of people indicated that they would put in an advance directive refusal of certain medication because they were ‘allergic’ to it. Any patient who tells a treating doctor they are allergic to, say, penicillin should be confident that they would not receive this drug. Some psychiatric patients, however, believed that telling a doctor they were ‘allergic’ to a particular drug would not prevent them being given it. This raises the question of what they mean by ‘allergic’. If patients mean that it causes, to them, unacceptable side-effects but have learnt that this is not an acceptable reason to psychiatrists for not prescribing it, they may be seeking what they believe to be a more acceptable ‘medical’ reason.

Advance statements are included in the new Mental Health (Care and Treatment) (Scotland) Act 2003 and may appear in new legislation in England and Wales. To serve their purpose, they need to be written clearly and unambiguously. If patients cite allergy as a reason for not receiving a drug and this can be overturned by a doctor who has a different understanding of what allergy means, the advance directive will not serve its purpose. It is more appropriate that psychiatrists work with patients to encourage them to express their concerns, accept them as legitimate and seek to overcome them, as many undoubtedly do, rather than patients adopt a possibly inappropriate term in an attempt to make their views heard.

Declaration of interest

Dr Atkinson and Ms Garner are in receipt of a research grant from the Nuffield Foundation funded to research advance directives.