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

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Georgetown University Press, Jul 18, 2001 - Law - 364 pages
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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 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.

 

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Contents

Decisional Capacity
172
The Right to Refuse Treatment
177
Demands for Treatment
182
Clinical Futility
187
An Integration of Ethical Issues
197
Advance Directives
219
The Social Justification for Advance Directives
228
General Problems with Advance Directives
233

The Social and Technological Background for the Patient SelfDetermination Act
47
The Expectations of Healthcare
48
The PhysicianPatient Relationship
51
The Technological Pressures on Healthcare Delivery
56
The Difficulty of Limiting Technology in Healthcare
58
Healthcare Costs and the Demands of Justice
61
The Human Context of the Patient SelfDetermination Act
77
The Recognition of Human Finitude
78
The Assertion of Personal Dignity
88
The Role of the Virtues in Conducting the Moral Life
99
The Institutional Context of the Patient SelfDetermination Act
125
The Social Obligations of Institutions
126
The Mission of the Institution
130
Healthcare Institutions as Centers of Education
135
The Ethical Foundations of the Patient SelfDetermination Act
147
The Supporting Principles of Bioethics
148
The Principle of Autonomy
149
The Principle of Beneficence
151
The Principle of Justice
153
The Principle of Parentalism
159
The Role of the Virtues in Clinical Decisions
162
Informed Consent
165
Advantages and Disadvantages of Advance Directives
237
Writing an Advance Directive
240
Content of Advance Directives
244
Assistance in Writing Advance Directives
248
The Roles of Healthcare Professionals
269
Preparing the Professional
270
The Role of the Physician
271
The Role of Social Services and Chaplaincy
276
The Role of Nursing
281
Perspective
284
The Role of the Responsible Patient
293
The Moral Responsibility for Making Decisions
295
Developing a Life of Virtue
298
Essential Virtues of the Responsible Patient
301
Being Informed
303
Being Assertive
305
Being Communicative
308
Taking Risks
310
Summary
312
Conclusion
321
Index
325
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Page 28 - If all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind.
Page 10 - We think that the State's interest contra weakens and the individual's right to privacy grows as the degree of bodily invasion increases and the prognosis dims.
Page 3 - Advance directive" means a written instruction, such as a living will or durable power of attorney for health care, recognized under State law relating to the provision of health care when the individual is incapacitated.

References to this book

About the author (2001)

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.

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