The Patient Self-Determination Act: A Legal Solution for a Moral Dilemma

1992 ◽  
Vol 1 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Jos V. M. Welie
Keyword(s):  
Decision Making ◽  
Advance Directive ◽  
Patient Autonomy ◽  
Moral Dilemma ◽  
Work Load ◽  
Professional Autonomy ◽  
Self Determination ◽  
The Law ◽  
Patient Self Determination Act

The Patient Self-Determination Act is a fact. Finally, respect for patient autonomy has been guaranteed. At first sight, there seems little reason to object to any measure that intends to increase the autonomy of the patient. Too long, one may argue, physicians have behaved paternalistically; too often, they have been advised to change this habit. If the profession of medicine is unwilling or simply unable to grant the patient the decision-making power that is her due, the law has to step in. One may add, this law in no way hinders professional autonomy; by requiring a hospital official to provide the patient with information about advance directive, the law actually reduces the work load of the physician, who is already overburdened.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals

2019 ◽  
Vol 18 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Oindrila Dutta ◽  
Priya Lall ◽  
Paul Victor Patinadan ◽  
Josip Car ◽  
Chan Kee Low ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patient Autonomy ◽  
Healthcare Professionals ◽  
Program Effectiveness ◽  
Self Determination ◽  
Truth Telling ◽  
Focus Group Study ◽  
Eol Care ◽  
Care Decision

AbstractObjectivesAsia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients’ autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.MethodsGuided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals’ attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.ResultsThe extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.Significance of resultsHealthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.

Implications of the patient self-determination act: Guidelines for involving adolescents in medical decision making

1996 ◽  
Vol 19 (5) ◽  
pp. 319-324 ◽  
Author(s):  
Mary Ann McCabe ◽  
Cynthia H. Rushton ◽  
Jacqueline Glover ◽  
Melinda G. Murray ◽  
Sanford Leikin
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Self Determination ◽  
Medical Decision ◽  
Patient Self Determination Act

The Patient Self-Determination Act: Potential Ethical Quandaries and Benefits

1992 ◽  
Vol 1 (2) ◽  
pp. 107-115 ◽  
Author(s):  
Ernlé W. D. Young ◽  
Shelli A. Jex
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Advance Directives ◽  
Patient Autonomy ◽  
Self Determination ◽  
Healthcare Facilities ◽  
Historical Trend ◽  
Patient Self Determination Act

As Part of the Omnibus Budget Reconciliation Act of 1990, the Patient Self Determination Act (PSDA) legislates new responsibilites for healthcare facilities. The authors served as members of the California Consortium on Patient Self-Determination, and the materials produced by this group offer healthcare facilities a valuable guide for implementing the PSDA. The ACt follows a historical trend led by doctrines of informed consent and increasing patient autonomy regarding rights to accept or refuse medical treatment and to execute advance directives. The requirements of the Act will influence healthcare facilities and how they communicate with patients about advance directives. Although the Act seeks to increase awareness of advance directices among all participants in healthcare interactions, it could pose major stumbling blocks to providing sensitive and humane care if certain concerns are nor addressed adequatley. The benefits of the Act could be far reaching and substantial for patients and healthcare facilities alike.

Beyond Canterbury: Can Medicine and Law Agree about Informed Consent? And Does It Matter?

2017 ◽  
Vol 45 (1) ◽  
pp. 106-111 ◽  
Author(s):  
Marc D. Ginsberg
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Patient Autonomy ◽  
The Law

Informed consent is central to the law of the physicianpatient relationship, respecting patient autonomy. This paper addresses a conflict between law and medicine in defining informed consent. Additionally, it addresses the possibility that patients prefer not to be “informed“ and would defer decision-making to their physicians.

scholarly journals THE GROWTH OF PATIENT AUTONOMY IN MODERN MEDICAL PRACTICE AND THE DEFINED LIMITATIONS UNDER THE SHARĪ’AH

2014 ◽  
Vol 22 (2) ◽  
Author(s):  
Puteri Nemie Jahn Kassim
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Patient Autonomy ◽  
Medical Decision Making ◽  
Self Determination ◽  
Medical Decision ◽  
Legal Cases ◽  
Modern Medical Practice ◽  
The Right ◽  
Islamic Values

The concept of patient autonomy or self-determination is one of the dominant ethos in modern medical practice. The demands by patients to be given respect, independence and dignity in medical decision making have been heeded and mirrored in many ethical codes and judicial decisions. The development of the law relating to informed consent, euthanasia, confidentiality, and reproduction issues have clearly reflected the reinforcement of patient autonomy in which patients’ choices should be free from coercion and unwanted interference. Paternalistic infringement in these areas have been regarded as outmoded and are disfavoured, as respect for a patient’s right to determine his own destiny is given precedence.  The escalating medico-legal cases have further emphasised the salience of this concept in the provision of medical services. Nevertheless, while the importance of patient autonomy is duly recognised, the advancement of this concept is not without its limitations; it accordingly has to evolve within the perimeters of one’s religious and cultural precepts. For Muslim patients, the right and ability to make their own choices and decisions about medical care and treatment must be within the defined limitations of the Sharī’ah. The emphasis on individualism, personal gratification and the denial of faith in medical decision making is inconsistent with Islamic values. Therefore it is necessary that principles relating to the concept of patient autonomy be developed within the sphere of the Sharī’ah, in order to ensure their coherence with the doctrinal requirements stipulated in Islam.

Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

Awareness and Decision Making in Professional Ethics

2000 ◽  
Vol 5 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Ronny Swain
Keyword(s):  
Decision Making ◽  
Professional Ethics ◽  
Ethical Decision Making ◽  
Code Of Ethics ◽  
Professional Autonomy ◽  
Ethical Awareness ◽  
Ethical Decisions ◽  
The Right ◽  
Aid Decision

The paper describes the development of the 1998 revision of the Psychological Society of Ireland's Code of Professional Ethics. The Code incorporates the European Meta-Code of Ethics and an ethical decision-making procedure borrowed from the Canadian Psychological Association. An example using the procedure is presented. To aid decision making, a classification of different kinds of stakeholder (i.e., interested party) affected by ethical decisions is offered. The author contends (1) that psychologists should assert the right, which is an important aspect of professional autonomy, to make discretionary judgments, (2) that to be justified in doing so they need to educate themselves in sound and deliberative judgment, and (3) that the process is facilitated by a code such as the Irish one, which emphasizes ethical awareness and decision making. The need for awareness and judgment is underlined by the variability in the ethical codes of different organizations and different European states: in such a context, codes should be used as broad yardsticks, rather than precise templates.

Scham und Autonomie

2012 ◽  
Vol 2012 (1) ◽  
pp. 163-192
Author(s):  
Sonja Rinofner-Kreidl
Keyword(s):  
Decision Making ◽  
Social Dynamics ◽  
Self Esteem ◽  
Self Determination ◽  
Intentional Content ◽  
Conceptual Clarification ◽  
The Social ◽  
Conventional Behavior ◽  
And Control

Autonomy is associated with intellectual self-preservation and self-determination. Shame, on the contrary, bears a loss of approval, self-esteem and control. Being afflicted with shame, we suffer from social dependencies that by no means have been freely chosen. Moreover, undergoing various experiences of shame, our power of reflection turns out to be severly limited owing to emotional embarrassment. In both ways, shame seems to be bound to heteronomy. This situation strongly calls for conceptual clarification. For this purpose, we introduce a threestage model of self-determination which comprises i) autonomy as capability of decision-making relating to given sets of choices, ii) self-commitment in terms of setting and harmonizing goals, and iii) self-realization in compliance with some range of persistently approved goals. Accordingly, the presuppositions and distinctive marks of shame-experiences are made explicit. Within this framework, we explore the intricate relation between autonomy and shame by focusing on two questions: on what conditions could conventional behavior be considered as self-determined? How should one characterize the varying roles of actors that are involved in typical cases of shame-experiences? In this connection, we advance the thesis that the social dynamics of shame turns into ambiguous positions relating to motivation, intentional content,and actors’ roles.

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