Implementing the PSDA for Psychiatric Patients: A Common- Sense Approach
Swisher, Karen N.
Journal of Clinical Ethics. 1991 Fall; 2(3): 199-205.
Conclusion: For most patients, the determination by health-care providers of capacity to consent is a common-sense matter. However, for psychiatric patients, determination of capacity to consent will require providers to objectively assess and adequately document competency if these patients desire to invoke a living will or medical power of attorney. Most jurisdictions have established that testamentary capacity is not the same as capacity for other legal matters. Thus, a person who is under the care of a legally appointed committee may still have testamentary capacity to invoke a living will. Commitment for mental illness raises the presumption of incapacity, but it is not conclusive. For example, a valid will may be written during a lucid period. If physicians are able to document capacity during a lucid period, courts generally will give a great deal of deference to physicians' evaluations. Evidence from physicians on the question of mental capacity, especially from those who attend to the patient, will be given great weight. Testamentary capacity requires the patient to be functionally capable of understanding information that is relevant to the decision he is making, communicating with providers regarding this decision, and considering relevant alternatives and consequences against a background of personal values and goals. The proposed model policy included in the Appendix should give health-care providers of psychiatric patients helpful guidelines for implementing the PSDA for their patients. It is important that all patients be assessed for competency to consent, so they may fill out a living will or medical power of attorney if they desire. Finally, the model policy gives guidelines for how family members can consent on behalf of their incapacitated loved ones. Because state laws necessarily vary on this subject, it is important to know the parameters of one's own laws and then to develop a proactive policy that will resolve these clinical decisions within the facility rather than in the courts. In this way patient autonomy, family cohesiveness, and the integrity of the medical profession can all be advanced.
Advance Directives; Allowing to Die; Alternatives; Autonomy; Clinical Ethics; Competence; Consent; Decision Making; Ethics; Expert Testimony; Family Members; Federal Government; Goals; Government; Government Regulation; Guidelines; Health; Health Facilities; Informed Consent; Institutional Policies; Illness; Legal Aspects; Legislation; Laws; Mental Illness; Patient Admission; Patient Care; Patient Care Team; Patients; Physicians; Public Policy; Power; Regulation; Right to Die; Standards; Third Party Consent; Values;
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Advance Directives: A Computer Assisted Approach to Assuring Patients' Rights and Compliance With PSDA (Patient Self-Determination Act) and JCAHO Standards Murphy, G. Don; Schenkenberg, Tom; Hunter, Jeff S.; Battin, Margaret P. (1997-09)
Advance Directives: A Computer Assisted Approach to Assuring Patients' Rights and Compliance With PSDA and JCAHO Standards Murphy, G. Don; Schenkenberg, Tom; Hunter, Jeff S.; Battin, Margaret P. (1997-09)