SELF-DETERMINATION FROM THE PRESIDENT’S COMMISSION TO THE PATIENT SELF-DETERMINATION ACT

ESSENTIALS “INDIVIDUAL’S EXERCISE OF THE CAPACITY TO FORM, REVISE, AND PURSUE PERSONAL PLANS FOR LIFE.” INFORMED BY VALUES & GOALS OF PATIENT GROUNDED IN PRINCIPLE OF AUTONOMY WELL-BEING OF PATIENT IS BEST DETERMINED BY THE INDIVIDUAL’S SUBJECTIVE JUDGMENT

INTRINSIC VALUE FREEDOM FROM OUTSIDE CONTROL FREEDOM TO BE A CREATOR –CREATE ONE’S OWN CHARACTER –DEFINE ONE’S OWN VALUES –BE TREATED AS SUBJECTS RATHER THAN AS OBJECTS

FOUNDATION OF PERSONAL RESPONSIBILITY CENTRAL TO DEMOCRATIC IDEALS CORE OF A SENSE OF ONE’S DIGNITY –RESPECTING PATIENTS’ RIGHT TO DEFINE AND PURSUE THEIR OWN VIEW OF WHAT IS GOOD IS A MAJOR FORM OF RESPECTING DIGNITY PIVOTAL ROLE OF ACCURATE AND RELEVANT INFORMATION [CONTEXT OF A LIFE OF VIRTUE]

LIMITATIONS ACTIONS ARE HARMFUL TO OTHERS MISAPPROPRIATION OF RESOURCES VIOLATION OF MORAL INTEGRITY OF CAREGIVERS VIOLATION OF STANDARDS OF MEDICINE –TREATMENTS THAT PROVIDE NO BENEFIT LACK OF DECISIONAL CAPACITY

ADVANCE DIRECTIVES AND SELF-DETERMINATION DOCUMENTED FORM OF SELF-DETERMINATION SPECIFIC INSTRUCTIONS –CRUZAN (1990) SPECIFIC WITH REGARD TO TREATMENT AND CONDITION - CLEAR AND CONVINCING EVIDENCE OF WISHES OF AN INCOMPETENT RESPECT FOR PATIENT’S VALUES, WISHES, GOALS EARLY DISCUSSION WITH PATIENTS ACTIVE PARTICIPATION IN DECISION-MAKING

THE PATIENT SELF-DETERMINATION ACT INSTITUTIONS RECEIVING MEDICARE AND MEDICAID ALL ADULT PATIENTS MUST BE NOTIFIED IN WRITING AT THE TIME OF ADMISSION –RIGHT TO REFUSE TREATMENT –RIGHTS UNDER STATE LAWS REGARDING ADVANCE DIRECTIVES –SUMMARIES OF INSTITUTION’S POLICIES REGARDING WITHHOLDING AND WITHDRAWING OF LIFE-SUSTAINING TREATMENTS INSTITUTIONS MAY NOT DISCRIMINATE ABOUT ADVANCE DIRECTIVES NOTIFICATION MUST BE DOCUMENTED ADVANCE DIRECTIVE INFORMATION MUST BE DOCUMENTED ON-GOING STAFF AND COMMUNITY EDUCATION PROGRAMS ON ADVANCE DIRECTIVES

THE ROLE OF THE RESPONSIBLE PATIENT ACCEPTING RESPONSIBILITY DEVELOPING A LIFE OF VIRTUE ESSENTIAL VIRTUES –EXERCISING AUTONOMY –BEING INFORMED –BEING ASSERTIVE –BEING COMMUNICATIVE –TAKING RISKS