Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples’ wishes, enabling people to have their say (to a point), we know what’s best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.

预先声明使精神健康患者能够在丧失能力的情况下在治疗决策中考虑他们的偏好，但他们的接受度很差。这是由于与服务用户、临床医生和机构优先事项相关的复杂且经常相互冲突的原因和因素，这些因素会影响临床实践。使用福柯式话语分析方法来探索 13 位心理健康临床医生如何定位他们与预先陈述相关的角色。从数据中得出了五个立场：考虑到人们的意愿、让人们有发言权（在一定程度上）、我们知道什么是最好的、有风险的消防以及杠杆和责任。话语实践证明并加强了患者、临床医生和更广泛系统之间的权力关系。