Il contratto di Ulisse in psichiatria alla luce della legge n. 219/2017 su consenso informato e disposizioni anticipate di trattamento

In contemporary bio-juridical debate, the expression 'Ulysses contract' is used to define a set of self-binding instruments through which a person who suffers from a mental disorder with a remitting-relapsing or cyclical pattern can make explicit their advance directives regarding psychiatric treatment (PAD), in anticipation of a crisis in which the subject's preferences may conflict with those previously expressed. Unlike other countries, Italy does not have a specific regulation regarding PAD; however, we believe that important hints may come from law 219/2017 regulating informed consent, advance directives and shared care planning. The aim of this paper is to provide an interpretation of shared care planning (SCP) in psychiatry and thus contribute to the discussion on the implementation of law 219/2017 for people with mental disorders. The article presents a description of PAD in the international context, highlights their value for the subject's self-determination, and considers obstacles and facilitators to advance directives in psychiatry resulting from the literature. Building on these elements and considering the SCP specificity, SCP is suggested as a tool for making advance decisions on treatment in the context of mental disorders, specifically of those with a remitting-relapsing or cyclical pattern. The study also points to the need for an interdisciplinary dialogue between the bioethical, legal and clinical field in order to confirm the validity of SCP in psychiatry, including with regards to Ulysses contracts, and to provide practical guidance to ensure its applicability.