Cover image for The Patient Self-Determination Act : meeting the challenges in patient care
The Patient Self-Determination Act : meeting the challenges in patient care
Ulrich, Lawrence P.
Personal Author:
Publication Information:
Washington, D.C. : Georgetown University Press, [1999]

Physical Description:
xii, 351 pages ; 24 cm.

Format :


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R726 .U39 1999 Adult Non-Fiction Central Closed Stacks

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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 the act as an important vehicle for improving the health care decision-making process, Lawrence P. Ulrich explains the act's social, legal, and ethical background 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 it 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.

Author Notes

Lawrence P. Ulrich, a professor of philosophy at the University of Dayton, serves as an ethics consultant for a number of medical institutions.

Reviews 1

Choice Review

Bioethicist Ulrich (Univ. of Dayton) analyzes the Patient Self Determination Act of 1990 from the perspective of an ethicist who asserts the existence of principles named autonomy, beneficence, justice, and paternalism (which are believed to govern the health provider's decisions) and the existence of asserted virtues: exercising autonomy, being informed, being assertive, being communicative, and taking risks (which are believed to govern the patient's decisions). Virtues are defined as character traits or habits that individuals choose in order to accomplish the goals they have set for themselves. Patients, the author argues, are obliged to be responsible persons who take the initiative to set goals, choose paths to achieve those goals, and choose the virtues necessary to accomplishing them. These virtues or goals, then, determine what the patient decides about whether or when to refuse treatment--viewed as the major issue addressed by the Act. The assumption is made that health care professionals will, all things being equal, otherwise choose to give treatment whenever treatment is available. The cultural background to the Act is extensively explored, the earlier established right to informed consent being seen as the foundation of the 1990 Act. All levels. J. E. Allen; University of North Carolina at Chapel Hill

Table of Contents

1 The Requirements of the Patient Self-Determination Act
The Explicit Demands of the Law
The Spirit of the Law
2 The Legal Background of the Patient Self-Determination Act
Ethics and the Law
The Case of Karen Ann Quinlan
The Case of William Bartling
The Case of Paul Brophy
THe Case of Nancy Cruzan
General Implications
3 The Social and Technological Background for the Patient Self-Determination Act
The Expectations of Healthcare
The Physician-Patient Relationship
The Technological Pressures on Healthcare Delivery
The Difficulty of Limiting Technology in Healthcare
Healthcare Costs and the Demands of Justice
4 The Human Context of the Patient Self-Determination Act
The Recognition of Human Finitude
The Asseriotn of Personal Dignity
The Role of the Virtues in Conducting the Moral Life
5 The Institutional Context of the Patient Self-Determination Act
The Social Obligations of Institutions
The Mission of the Institution
Healthcare Institutions as Center of Education
6 The Ethical Foundations of the Patient Self-Determination Act
The Supporting Principles of Bioethics
The Role of the Virtues in Clinical Decisions
Informed Consent
Decisional Capacity
The Right to Refuse Treatment
Demands for Treatment
Clinical Futility
An Integration of Ethical Issues
7 Advance Directives
The Nature of Advance Directives
The Social Justification for Advance Directives
General Problems with Advance Directives
Advantages and Disadvantages of Advance Directives
Writing an Advance Directive
Content of Advance Directives
Assistance in Writing Advance Directives
8 The Roles of Healthcare Professionals
Preparing the Professional
The Role of the Physician
The Role of Social Services and Chaplaincy
The Role of Nursing
9 The Role of the Responsible Patient
Setting the Stage
The Moral Responsibility for Making Decisions
Developing a Life of Virtue
Essential Virtues of the Responsible Patient