The Patient Self-Determination Act: Meeting the Challenges in Patient Care

by Lawrence P. Ulrich

Overview

The Patient Self-Determination Act of 1990 required medical facilities to provide patients with written notification of their right to refuse or consent to medical treatment. Using this Act as an important vehicle for improving the health care decisionmaking process, Lawrence P. Ulrich explains the social, legal, and ethical background to the Act by focusing on well-known cases such as those of Karen Quinlan and Nancy Cruzan, and he explores ways in which physicians and other caregivers can help patients face the complex issues in contemporary health care practices.

According to Ulrich, health care facilities often address the letter of the law in a merely perfunctory way, even though the Act integrates all the major ethical issues in health care today. Ulrich argues that well-designed conversations between clinicians and patients or their surrogates will not only assist in preserving patient dignity — which is at the heart of the Act—but will also help institutions to manage the liability issues that the Act may have introduced. He particularly emphasizes developing effective advance directives. Ulrich examines related issues, such as the negative effect of managed care on patient self-determination, and concludes with a seldom-discussed issue: the importance of being a responsible patient.

Showing how the Patient Self-Determination Act can be a linchpin of more meaningful and effective communication between patient and caregiver, this book provides concrete guidance to health care professionals, medical ethicists, and patient-rights advocates.

Product Details

ISBN-13:	9781589014534
Publisher:	Georgetown University Press
Publication date:	07/18/2001
Series:	Clinical Medical Ethics series
Sold by:	Barnes & Noble
Format:	eBook
Pages:	364
File size:	18 MB
Note:	This product may take a few minutes to download.
Age Range:	18 Years

About the Author

Lawrence P. Ulrich, a professor of philosophy at the University of Dayton, serves as an ethics consultant for a number of medical institutions. His extensive writings about health care ethics include several training programs for health care professionals.

Table of Contents

Introduction

1. The Requirements of the Patient Self-Determination ActThe Explicit Demands of the LawThe Spirit of the Law

2. The Legal Background of the Patient Self-Determination ActEthics and the LawThe Case of Karen Ann QuinlanThe Case of William BartlingThe Case of Paul BrophyTHe Case of Nancy CruzanGeneral Implications

3. The Social and Technological Background for the Patient Self-Determination ActThe Expectations of HealthcareThe Physician-Patient RelationshipThe Technological Pressures on Healthcare DeliveryThe Difficulty of Limiting Technology in HealthcareHealthcare Costs and the Demands of Justice

4. The Human Context of the Patient Self-Determination ActThe Recognition of Human FinitudeThe Asseriotn of Personal DignityThe Role of the Virtues in Conducting the Moral Life

5. The Institutional Context of the Patient Self-Determination ActThe Social Obligations of InstitutionsThe Mission of the InstitutionHealthcare Institutions as Center of Education

6. The Ethical Foundations of the Patient Self-Determination ActThe Supporting Principles of BioethicsThe Role of the Virtues in Clinical DecisionsInformed ConsentDecisional CapacityThe Right to Refuse TreatmentDemands for TreatmentClinical FutilityAn Integration of Ethical Issues

7. Advance DirectivesThe Nature of Advance DirectivesThe Social Justification for Advance DirectivesGeneral Problems with Advance DirectivesAdvantages and Disadvantages of Advance DirectivesWriting an Advance DirectiveContent of Advance DirectivesAssistance in Writing Advance Directives

8. The Roles of Healthcare ProfessionalsPreparing the ProfessionalThe Role of the PhysicianThe Role of Social Services and ChaplaincyThe Role of NursingPerspective

9. The Role of the Responsible PatientSetting the StageThe Moral Responsibility for Making DecisionsDeveloping a Life of VirtueEssential Virtues of the Responsible PatientSummary

Conclusion

Index

What People are Saying About This

Edmund D. Pellegrino

This very complete analysis of the legal and ethical foundations of the [Patient Self-Determination] Act is a valuable guide for health care professionals, lawyers, and policy makers as well as the educated public.

Richard A. McCormick

Ulrich’s treatment of the Self-Determination Act is by far the best available. I am particularly impressed by the full and very rich analysis he provides for understanding the Act.

From the Publisher

"This very complete analysis of the legal and ethical foundations of the [Patient Self-Determination] Act is a valuable guide for health care professionals, lawyers, and policy makers as well as the educated public."—Edmund D. Pellegrino, MD, chair, President's Council on Bioethics, 2005-2009, and professor emeritus of medicine and medical ethics, Center for Clinical Bioethics, Georgetown University Medical Center

"This book is a portrait of the strengths and weaknesses of the ethics of advance directives and legislation supporting it. It would be hard to image any other work matching it for comprehensiveness and insight."—David C. Thomasma, Stritch School of Medicine, Loyola University Chicago

"This timely book should be read and used by all health care professionals responsible for the care of critically ill patients, every member of institutional ethics committees, ethics consultants, senior institutional managers, and patients and their families."—Laurence B. McCullough, Center for Medical Ethics and Health Policy, Baylor College of Medicine

"Ulrich's treatment of the Self-Determination Act is by far the best available. I am particularly impressed by the full and very rich analysis he provides for understanding the Act."—Richard A. McCormick, SJ, University of Notre Dame

Laurence B. McCullough

This timely book should be read and used by all health care professionals responsible for the care of critically ill patients, every member of institutional ethics committees, ethics consultants, senior institutional managers, and patients and their families.

David C. Thomasma

This book is a portrait of the strengths and weaknesses of the ethics of advance directives and legislation supporting it. It would be hard to image any other work matching it for comprehensiveness and insight.

Editorial Reviews

4 Stars! from Doody

This is a comprehensive account of the Patient Self-Determination Act (PSDA), passed in 1990. The purpose is to describe a comprehensive context for implementing the PSDA. This includes demonstrating its impact on healthcare and describing the role of healthcare professionals in moving beyond the letter of the law. This book seems to fill a void. The editor's objectives have been met. This book is written for healthcare professionals, but it seems like others such as medical ethicists would find it beneficial. The editor is credible; his background is in philosophy, but it is clear that he has extensive clinical experience as an ethics consultant. A wide range of areas related to the PSDA are covered, including a review of the Act's requirements, the legal and social background leading to it, the human and institutional context of its implementation, the ethical foundations of the PSDA, and the roles of healthcare professionals and responsible patients. Healthcare professional get a deeper understanding of the ethical, social, and legal components. Medical ethicist get a deeper understanding of the clinical and institutional contexts. When the editor identifies shortcomings in the implementation of the PSDA, he follows with thorough recommendations for change. The chief feature of this book is its breadth. This book is a unique contribution to the field and the editor offers a fair and comprehensive assessment of issues raised by the PSDA. The editor does not sacrifice detail for breadth, and due to its breadth, and the breadth of the PSDA itself, this book should be useful to many.

Susan Parry

...offers a wealth of knowledge of possible great interest to bioethicists, caregivers, health policy makers, members of institutional ethics committees, and lawyers.

Journal of the American Medical Association

Ulrich (philosophy, U. of Dayton) explains the social, legal, and ethical background to the Patient Self-Determination Act of 1990, which required medical facilities to give patients written notification of their right to refuse or consent to medical treatment. He uses case studies to explore this as well as related issues such as the effect of managed care on patient self- determination, and how to be a responsible patient, emphasizing throughout that the key to all of the issues involved is good communication between doctor and patient. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Booknews

Brings some light to those lost in the darkness of properly defining the boundaries of the patient's role in the health care decision making process . . . offers a wealth of knowledge to bioethicists, caregivers, health policy makers, members of institutional ethics committees, and lawyers.

JAMA (Journal of the American Medical Association)

Reviewer: Susan Parry, MA (University of Minnesota)
Description: This is a comprehensive account of the Patient Self-Determination Act (PSDA), passed in 1990.
Purpose: The purpose is to describe a comprehensive context for implementing the PSDA. This includes demonstrating its impact on healthcare and describing the role of healthcare professionals in moving beyond the letter of the law. This book seems to fill a void. The editor's objectives have been met.
Audience: This book is written for healthcare professionals, but it seems like others such as medical ethicists would find it beneficial. The editor is credible; his background is in philosophy, but it is clear that he has extensive clinical experience as an ethics consultant.
Features: A wide range of areas related to the PSDA are covered, including a review of the Act's requirements, the legal and social background leading to it, the human and institutional context of its implementation, the ethical foundations of the PSDA, and the roles of healthcare professionals and responsible patients. Healthcare professional get a deeper understanding of the ethical, social, and legal components. Medical ethicist get a deeper understanding of the clinical and institutional contexts. When the editor identifies shortcomings in the implementation of the PSDA, he follows with thorough recommendations for change. The chief feature of this book is its breadth.
Assessment: This book is a unique contribution to the field and the editor offers a fair and comprehensive assessment of issues raised by the PSDA. The editor does not sacrifice detail for breadth, and due to its breadth, and the breadth of the PSDA itself, this book should be useful to many.

Doody's Review Service

Ulrich’s treatment of the Self-Determination Act is by far the best available. I am particularly impressed by the full and very rich analysis he provides for understanding the Act.

Richard A. McCormick

This book is a portrait of the strengths and weaknesses of the ethics of advance directives and legislation supporting it. It would be hard to image any other work matching it for comprehensiveness and insight.

David C. Thomasma

This very complete analysis of the legal and ethical foundations of the [Patient Self-Determination] Act is a valuable guide for health care professionals, lawyers, and policy makers as well as the educated public.

Edmund D. Pellegrino

This timely book should be read and used by all health care professionals responsible for the care of critically ill patients, every member of institutional ethics committees, ethics consultants, senior institutional managers, and patients and their families.

Laurence B. McCullough