The Patient Self-Determination Act: A Legal Solution for a Moral Dilemma
Welie, Jos V.M.
Cambridge Quarterly of Healthcare Ethics. 1992 Winter; 1(1): 75-79.
The Patient Self-Determination Act is a fact. Finally, respect for patient autonomy has been guaranteed. At first sight, there seems little reason to object to any measure that intends to increase the autonomy of the patient. Too long, one may argue, physicians have behaved paternalistically; too often, they have been advised to change this habit. If the profession of medicine is unwilling or simply unable to grant the patient the decision-making power that is her due, the law has to step in. One may add, this law in no way hinders professional autonomy; by requiring a hospital official to provide the patient with information about advance directives, the law actually reduces the work load of the physician, who is already overburdened. Despite these apparent positive aspects, this law actually is one more step on a very regrettable path. By itself, the law is not very troublesome, although, as we will see in a moment, there are some pragmatic problems. However, the law reflects an ideological development that is very distressing yet seems impossible to halt. In the following article, both pragmatic and ideological problems will be discussed, followed by a brief comparison between this law and similar developments in one European country, The Netherlands. Suggestions will be made regarding possible long- and short-term alternatives.
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