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Ulysses arrangements in psychiatry: a matter of good care?
  1. I Gremmen1,
  2. G Widdershoven2,
  3. A Beekman3,
  4. R Zuijderhoudt4,
  5. S Sevenhuijsen5
  1. 1
    Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands
  2. 2
    Maastricht University, Maastricht, The Netherlands
  3. 3
    Free University Medical Centre, Amsterdam, The Netherlands
  4. 4
    Zuijderhoudt Consultancy, The Hague, The Netherlands
  5. 5
    Utrecht University, Utrecht, The Netherlands
  1. Dr I Gremmen, Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands; i.gremmen{at}


This article concerns the issue of how an ethic of care perspective may contribute to both normative theory and mental health care policy discussions on so called Ulysses arrangements, a special type of advance directives in psychiatry. The debate on Ulysses arrangements has predominantly been waged in terms of autonomy conceived of as the right to non-intervention. On the basis of our empirical investigations into the experiences of persons directly involved with Ulysses arrangements, we argue that a care ethics perspective may broaden and deepen the debate on Ulysses arrangements, by introducing additional concepts, such as vulnerability, responsibility and mutuality, and by refining familiar concepts, such as autonomy.

  • medical ethics
  • ethics of care
  • advance directives
  • psychiatry

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  • Funding: The research project described has been funded by The Netherlands Organisation for Scientific Research (NWO) from 1999 to 2002 with no further involvement.

  • Competing interests: None.

  • iWe prefer the term Ulysses “arrangement” to the terms “contract” or “statement” that may be found as well. The term “contract” may put too much emphasis on juridical aspects; “statement” has the connotation of a one-sided declaration, whereas the term “arrangement” suggests that both in the formulation and in the application others are involved. This is one reason why Ulysses arrangements may be considered a special type of advance directive. Another special characteristic is that Ulysses arrangements concern temporary situations that patients have experienced earlier.