The Patient Self-Determination Act

Meeting the Challenges in Patient Care

Lawrence P. Ulrich

"This very complete analysis of the legal and ethical foundations of the [Patient Self-Determination] Act is a valuable guide for health care professionals, lawyers, and policy makers as well as the educated public."
+ Add to Cart Preorder


Request Print Exam Copy

Request Digital Exam Copy

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.

Table of Contents


1. The Requirements of the Patient Self-Determination Act
The Explicit Demands of the Law
The Spirit of the Law

2. The Legal Background of the Patient Self-Determination Act
Ethics and the Law
The Case of Karen Ann Quinlan
The Case of William Bartling
The Case of Paul Brophy
THe Case of Nancy Cruzan
General Implications

3. The Social and Technological Background for the Patient Self-Determination Act
The Expectations of Healthcare
The Physician-Patient Relationship
The Technological Pressures on Healthcare Delivery
The Difficulty of Limiting Technology in Healthcare
Healthcare Costs and the Demands of Justice

4. The Human Context of the Patient Self-Determination Act
The Recognition of Human Finitude
The Asseriotn of Personal Dignity
The Role of the Virtues in Conducting the Moral Life

5. The Institutional Context of the Patient Self-Determination Act
The Social Obligations of Institutions
The Mission of the Institution
Healthcare Institutions as Center of Education

6. The Ethical Foundations of the Patient Self-Determination Act
The Supporting Principles of Bioethics
The Role of the Virtues in Clinical Decisions
Informed Consent
Decisional Capacity
The Right to Refuse Treatment
Demands for Treatment
Clinical Futility
An Integration of Ethical Issues

7. Advance Directives
The Nature of Advance Directives
The Social Justification for Advance Directives
General Problems with Advance Directives
Advantages and Disadvantages of Advance Directives
Writing an Advance Directive
Content of Advance Directives
Assistance in Writing Advance Directives

8. The Roles of Healthcare Professionals
Preparing the Professional
The Role of the Physician
The Role of Social Services and Chaplaincy
The Role of Nursing

9. The Role of the Responsible Patient
Setting the Stage
The Moral Responsibility for Making Decisions
Developing a Life of Virtue
Essential Virtues of the Responsible Patient




"Brings some light to those lost in the darkness of properly defining the boundaries of the patient's role in the health care decision making process . . . offers a wealth of knowledge to bioethicists, caregivers, health policy makers, members of institutional ethics committees, and lawyers."—JAMA (Journal of the American Medical Association)

"This very complete analysis of the legal and ethical foundations of the [Patient Self-Determination] Act is a valuable guide for health care professionals, lawyers, and policy makers as well as the educated public."—Edmund D. Pellegrino, MD, chair, President's Council on Bioethics, 2005-2009, and professor emeritus of medicine and medical ethics, Center for Clinical Bioethics, Georgetown University Medical Center

"This book is a portrait of the strengths and weaknesses of the ethics of advance directives and legislation supporting it. It would be hard to image any other work matching it for comprehensiveness and insight."—David C. Thomasma, Stritch School of Medicine, Loyola University Chicago

"This timely book should be read and used by all health care professionals responsible for the care of critically ill patients, every member of institutional ethics committees, ethics consultants, senior institutional managers, and patients and their families."—Laurence B. McCullough, Center for Medical Ethics and Health Policy, Baylor College of Medicine

"Ulrich’s treatment of the Self-Determination Act is by far the best available. I am particularly impressed by the full and very rich analysis he provides for understanding the Act."—Richard A. McCormick, SJ, University of Notre Dame


Supplemental Materials


About the Author

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.

364 pp., 6 x 9

Sep 1999

364 pp., 6 x 9

ISBN: 978-0-87840-748-4
Sep 1999

364 pp.

ISBN: 978-1-58901-453-4
Sep 1999

Clinical Medical Ethics series
H. Tris Engelhardt and Kevin Wm. Wildes, Series Editors

Related Titles