The New Patient Self-Determination Act

My latest Legal Briefing column, “The New Patient Self-Determination Act,” has just been published in The Journal of Clinical Ethics 24(2).  

In this Article, I cover recent legal developments involving the Patient Self-Determination Act (PSDA).  Enacted in the wake of the U.S. Supreme Court’s Cruzan decision in 1990, the PSDA remains a seminal event in the development of U.S. bioethics public policy.  But the PSDA has long been criticized as inadequate and ineffective. Finally, recent legislative and regulatory changes promise to revitalize and rejuvenate it.  I categorize new legal developments concerning the PSDA into the following eight sections:

    1.  Background and History

    2.  Rules and Requirements

    3.  Criticism and Challenges

    4.  Failed Efforts to Amend the PSDA

    5.  Personalize Your Care Act of 2013

    6.  New Regulations

    7.  New Regulatory Guidance

    8.  Expanded Enforcement

Much of the rest of the Summer 2013 issue also concerns end-of-life and surrogate decision making, so here is the complete TOC:

Why Careproviders May Conclude that Treating a Patient Is Futile
Edmund G. Howe

Repetitive Foreign Body Ingestion: Ethical Considerations
Sarah Lytle, Susan J. Stagno, and Barb Daly 

The Intensity and Frequency of Moral Distress Among Different Healthcare Disciplines
Susan Houston, Mark A. Casanova, Marygrace Leveille, Kathryn L. Schmidt,
Sunni A. Barnes, Kelli R. Trungale, and Robert L. Fine 

“He Got His Last Wishes”: Ways of Knowing a Loved One’s End-of-Life Preferences and Whether Those Preferences Were Honored
Angelina R. Wittich, Beverly Rosa Williams, F. Amos Bailey, Lesa L. Woodby, and
Kathryn L. Burgio 

Making Decisions for Hospitalized Older Adults: Ethical Factors Considered by Family Surrogates
Jenna Fritsch, Sandra Petronio, Paul R. Helft, and Alexia M. Torke 

The Threshold Moment: Ethical Tensions Surrounding Decision Making on Tracheostomy for Patients in the Intensive Care Unit
Arvind Venkat 

A Response to Dubler’s Commentary on “Surmounting Elusive Barriers: The Case for Bioethics Mediation”
Edward J. Bergman 

 The Art of the Chart Note in Clinical Ethics Consultation and Bioethics Mediation: Conveying Information that Can Be Understood and Evaluated
Nancy Neveloff Dubler 

 Legal Briefing: The New Patient Self-Determination Act
Thaddeus Mason Pope