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.

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.

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