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.

Response to “Reassessing the Reliability of Advance Directives” by Thomas May (CQ Vol. 6, No. 5)

1998 ◽  
Vol 7 (4) ◽  
pp. 405-413 ◽  
Author(s):  
Christopher Tollefsen
Keyword(s):  
Informed Consent ◽  
Advance Directives ◽  
Patient Autonomy ◽  
Recent Article ◽  
Prima Facie ◽  
Modern Medicine ◽  
Moral Principles ◽  
Patient’S Autonomy

In a recent article Thomas May has argued that the use of advance directives (ADs) to respect a no longer competent patient's autonomy is a failed strategy. Respect for patient autonomy is clearly one of the guiding moral principles of modern medicine, and its importance is reflected in medical emphasis on informed consent. Prima facie, at least, ADs seem likewise to respect patient autonomy by allowing patients to make decisions about treatment in advance of situations in which the patient may no longer be able to specify the form of treatment desired. So a claim that ADs do not extend patient autonomy to these situations of diminished competence represents a serious criticism of our understanding not only of advance directives, but of autonomy as well.

When Any Answer Is a Good Answer: A Mandated-Choice Model for Advance Directives

2010 ◽  
Vol 19 (3) ◽  
pp. 417-421 ◽  
Author(s):  
JACOB APPEL
Keyword(s):  
Nursing Homes ◽  
Medical Treatment ◽  
Advance Directives ◽  
Choice Model ◽  
Terminally Ill ◽  
Living Will ◽  
Self Determination ◽  
Federal Funds ◽  
Choice Of Care ◽  
Striking Contrast

Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, billed at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts.

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.

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