Advance directives on admission: clinical implications and analysis of the Patient Self-Determination Act of 1990

Article Abstract:

Individuals can write advance directives, such as living wills and durable powers of attorney, to ensure that their wishes concerning their medical care will be known and carried out. Competent persons can use advance directives to indicate consent or refusal of health care under certain conditions. To encourage the use of these advance directives, the Patient Self-Determination Act will take effect on December 1, 1991. The act requires medical care providers to tell patients about their right to accept or refuse medical care. However, many problems remain. Studies have found that living wills decrease anxiety about death and are related to a feeling of internal control. In spite of this, very few patients complete living wills even after discussion about them. Many physicians feel that living wills are a patient's responsibility, and are often uncomfortable discussing them, even though research indicates that informing patients helps decrease their anxiety. There is evidence that even when a patient executes an advance directive regarding medical care, it does not increase the likelihood that the patient's wishes will be followed, nor even that the directive would be kept with the patient's chart. However, the act will probably encourage discussion, and provisions are included to ensure that efforts to honor patient preferences will increase. Making the forms comprehensible, especially for very ill patients, will be a challenge. Legal and ethical barriers to the implementation of the act are discussed, including the possibility that the forms will be used to the detriment of the poor and the indigent. Recommendations for improving the effectiveness of the act are proposed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Living wills, Durable power of attorney

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The illusion of patient choice in end-of-life decisions

Article Abstract:

Since the 1970s, the general consensus has been that decisions regarding life-sustaining treatment should be based on the values and wishes of the patient. Research studies suggest that these decisions are more often based on the values of the physician. Physicians may not know a patient's wishes, they may feel uncomfortable asking about them, or feel that they are not important. Patients' wishes may be influenced by the opinions of their physician, and many patients defer treatment decisions to their physician. The concept of patient participation in treatment decisions is relatively new, and it may take more time for this concept to be practiced. Under the informed consent law, physicians must obtain consent from their patients before treatment. But when this law is violated, the burden of proof is put upon the patient rather than the physician. Physicians should not impose their values on their patients, and more courses on medical ethics should be provided in medical schools. Laws that protect patients' rights should be strengthened, and patients should learn their doctor's views on end-of-life decisions.

Planning, Terminally ill persons, Terminally ill, Ethical aspects, Medical care decision-making authority (Law), Medical care decision making authority (Law)

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The Pain Relief Promotion Act of 1999: A Serious Threat to Palliative Care

Article Abstract:

The proposed Pain Relief Promotion Act (PRPA) of 1999 might have a devastating impact on terminal care in the US. This bill was introduced in Congress to prevent Oregon doctors from implementing the Death With Dignity Act. This 1996 law allows Oregon doctors to participate in assisted suicide on behalf of terminally ill patients. PRPA would make it a crime for any doctor to give a patient a controlled substance such as opioids to hasten death. However, this might prevent doctors from adequately treating pain for fear of liability. There are other bills pending in Congress that would better serve doctors and their terminally ill patients.

Laws, regulations and rules, Prevention, Terminal care, Assisted suicide, Palliative treatment, Palliative care

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