Advance directives in mental health in Chile: Challenges and the urgency of a postponed conversation

Abstract

Advance directives in mental health are legal instruments designed to protect autonomy, self-determination, and quality of life, during psychiatric crises. In Chile, although Law N°21.331 recognizes their legal validity, significant challenges persist in their implementation. This reflection highlights the lack of official ministerial guidelines, the limited inclusion of bioethical debate in healthcare training, and scarce research on the mechanisms for revocation of these directives. Additionally, the infantilization of individuals receiving psychiatric care is discussed as a cultural and systemic barrier to effective adoption of advance directives in mental health. This article argues for the urgent development of a comprehensive legislative and ethical framework that promotes patient rights and active participation in treatment decisions, ensuring these instruments are both accessible and operational within mental health services.