Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...) rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

ABSTRACT -/- Ayurveda is science of living being with an aim to live healthy life and curing of ailments. Arogyata (healthy life) is root to achieve the purushartha chatushtaya which are dharma(religious rituals), artha, kama and moksha. Kama in society is taken in sexual lust but Vatsayan has described kama as the enjoyment of appropriate objects by the five senses of hear- ing, feeling, seeing, tasting, and smelling, assisted by the mind together with the soul. The ingre- dient in this (...) is a peculiar contact between the organ of sense and its object, and the consciousness of pleasure which arises from that contact is called Kama. A well organised, controlled form of kama comes under brahmacharya. Acharya Charaka has specified brahmacharya among three subpillars which assists in healthy living being. Brahmacharya leads to conservation of shukra dhatu which is essence of ahara. This shukra dhatu is responsible for bala, virya, yash, dhairya, preeti. Development of these qualities assists higher faculty buddhi or pragya not to indulge in pragyaparadh leading to correct decisionary power and patience. Healthy state of mind is achieved with this brahmacharya. Through this paper a review over various parameters of brah- macharya have been discussed and concluded. -/- Keywords: Kama, dhairya, pragyaparadh, health, shukra dhatu. (shrink)