The Patient Self-Determination Act: yes.

The Patient Self-Detemination Act: Yes The Patient Self-Determination Act (especially post-Cruzan) will be a vital public policy expression of a larger societal commitment to prevent the ill effects in the first case above and to increase the benefits of preparedness and shared decisionmaking so clear in the second. In Case 1, a deep dispute grew between the family and the ICU staff, in part because no advance directive had been provided by a neurologically devastated patient. The hospital ethics committee's consultant could not mediate the conflict and everyone involved suffered and remained angry. The patient died laboriously with multiple complications, still intubated, after eleven days of futile treatments. In Case 2, by contrasts, with a valid advance directive, decision-makers moved quickly to stop all measures needlessly prolonging the patient's life, and she died peacefully. Her husband recovered from his grief and is doing well. Readers who desire fewer Case 1s and more Case 2s will support the Act because it requires that adult, capable patients be informed about advance directives and durable powers of attorney and be offered the opportunity to execute these documents during a hospital admission. In Case I, one early "window of opportunity" was missed. During admission for a minor stroke, the patient could have been asked by a physician or nurse (not an admissions clerk, as Professor Capron assumes) during history-taking: "You know that hospitals have many ways to prolong life. If you do have a major stroke that cannot be treated, and you begin to die, what are your wishes about treatment? Do you want 'everything done' no matter how close to death you are ? Or do you want to limit treatment only to medication for pain and comfort care until you die?" Either, way, his wishes could have been recorded in the chart. If he had chosen to limit treatment, he could have been told about advance directives and offered the opportunity to execute a valid directive during that hospital admission. The Act has three main goals: the first is to give every adult during a hospital or nursing home stay an opportunity to learn about end-of-life choices and the option to sign an advance directive and durable power of attorney in case of incapacity. These two documents together are the best protection that society has for persons who desire the least and most merciful treatment in a terminal illness, especially when incapacity sets in. Despite years of "voluntary" education about living wills, only nine percent of Americans have such documents. Few Americans have these instruments because the opportunities to learn about them, to decide, and to be helped to execute them are meager. The Act embodies a collective desire to do better! The law is directed to institutions where the opportunity to educate is optimal and where eighty percent of Americans die. The Act does not preclude physicians in the community from educating their patients. The second goal of the bill is to provide the most supportive institutional climate in which to implement the first goal. To this end, the bill requires an institutional ethics committee in the facilities to which it applies. Hospital ethics committtees grew rapidly in the 1980s, but many institutions stil do not have them. Only 30 percent of hospitals in Virginia, for example, have a functioning ethics committee. …