Using Ulysses Contracts to prevent patients from spiralling into relapse

By Harriet Standing

Many people have written about Ulysses contracts in relation to the treatment of patients with mental illnesses. However, previous discussions have not focused on the particular phenomenon known as ‘spiralling’.

The inspiration for this paper came from a friend with bipolar disorder. Over the years, they had suffered the relapsing and remitting nature of the disorder, and it became apparent that there were certain symptoms and signs that they were heading towards a relapse. This is a phenomenon labelled as spiralling. During a relapse, they made regrettable decisions and suffered the consequences for these. Ulysses contracts offer a way for someone with an episodic mental illness, such as bipolar, to protect themselves from spiralling and ultimately relapsing.

A Ulysses contract is a written contract in which an individual deliberately limits their own options in the future, for example outlining specific circumstances under which they wish to receive appropriate medical treatment – even if, at the time, they refuse. They are highly controversial however, because they involve over-riding an individual’s current wishes, even though they may be judged to be competent (despite spiralling).

In “Ulysses Contracts in Psychiatric Care: Helping Patients to Protect Themselves from Spiralling”, my co-author Rob Lawlor and I argue that people who are vulnerable to spiralling deserve a way to protect their autonomy, and we provide four arguments in defence of Ulysses contracts, as well as outline a number of safeguards to limit the risks associated with these contracts.


Paper title: Ulysses Contracts in Psychiatric Care: Helping Patients to Protect Themselves from Spiralling

Authors: Harriet Standing1 and Rob Lawlor2


1 Leeds Teaching Hospitals NHS Trust, UK

2 Inter-Disciplinary Ethics Applied Centre, University of Leeds, Leeds, UK

Competing interests: None

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