The Patient Self-Determination Act of 1990 requires medical institutions and facilities to notify their patients that 1) they have the right to accept or refuse treatment 2) they have the right regarding advance directives, and 3) any policies the institution has regarding the withholding or withdrawing of life-sustaining treatments (Ulrich,2001, p. 9). The law is based on the principle of informed consent and was inspired from the case of Nancy Cruzan, who was in a vegetative state for seven years after suffering from a severe brain injury due to a car accident.
Her parents had requested that the hydration and feeding of their daughter be terminated to let her die in peace but was refused by the hospital. The Supreme Court had affirmed that artificial treatments that prolong life may be rejected if that is the intent of the patient but at the same time the state can enact reasonable rules of proof of intent. Cruzan was not able to communicate and therefore had no means to state her intent. Cruzan’s case clearly illustrates the value of advance directive (Ulrich, 2001, pp. 32-33).
B. Timeline 1914- The concept of informed consent was traced back to court decision on the Schloendorff versus Society of New York Hospital case in 1914. Physicians are made liable in performing operations /treatments without the patients consent. 1957- The term “informed consent” was used in the court decision of the Salgo versus Leland Standford University Board of Trustees. The physician is held liable if he did not disclose any information that is important in the consent decision-making of patient regarding treatments. 1972- The court decision on the Canterbury versus Spence strengthens the patient’s
right to self-determination as well as obliging the physician to disclose information regarding the risks, alternatives, and benefits of treatment as well as possible outcome of treatments. 1990- Congress passed the Patient Self-Determination Act (PSDA) which was made effective in 1991. It essentially requires health institutions and medical facilities to inform patients of their rights to be involved in decision-making as well as formulate advance directives. It was inspired from the court case of Nancy Cruzan who had no ability to express consent.
1993- The court decision of Arato versus Avedon case obligates physicians to provide statistical data of patient’s life expectancy so that a patient can align his decisions and activities on his remaining days. C. “Informed Consent” means that before a physician can perform operation or treatment he must first secure consent to do it. In securing consent, it is his duty to provide and disclose information on the risks, benefits, nature of the procedure, alternatives and possible outcomes of the procedure as well as provide statitistical data on life expectancy.
First and foremost, consent must be secured from the patient himself if he is of legal age and of a sound mind. In cases where this is not so, consent from the parents, legal guardian, relatives or individual obligated by court order must be secured. In emergencies wherein possible death or severe injury may result if treatment is withheld, and the adult patient is unconscious or delirious but time factor is not so crucial, consent may be acquired from the guardian or relative.
However, if time is crucial, and there is no indication that the patient resists the treatment, the physician is excused from the duty of inform consent. In researches, informed consent must first be secured from those who will participate in the test. In cases where an adult person could not express an intent or consent the existing laws of the state will serve as a guideline to securing consent (either from parents, relatives or guardians (Wilson, 1997, pp. 53-60; Faden et. al, 1986, p. 36. ). References “Arato versus Avedon “.
(1993). Case Summaries: Informed Consent. 16 February 2009 from http://www. lawandbioethics. com/demo/Main/LegalResources/C5/Arato. htm Faden, R. R, T. L. Beauchamp and N. M. King. (1986). A History and theory of informed consent. New York: Oxford University Press US. Ulrich, L. P. (2001). The patient self-determination act: Meeting the challenges in patient care. Washington, DC: Georgetown University Press. Wilson, Bettye G. (1997). Ethics and basic law for medical imaging professionals . Philadelphia: F. A. Davis Company.