Advance Directives and Surrogate Laws

Abstract

The Patient Self-Determination Act has spawned a great deal of activity by states as well as by hospitals. Advance directives have become firmly established by law, and statutes establishing hierarchies of surrogates have proliferated. Such activities are intended to foster informed patient choice when it comes to end-of-life matters. Whether, ultimately, they will do this or whether they will, in fact, reduce ethical medical decision making will depend on the way these instruments and laws are used. In this article, I caution against the almost unbridled enthusiasm with which these steps have been greeted. Whether health care professionals will use these instruments to enhance dialogue and to see choice as being made not only by and for individuals but by and for individuals who are enmeshed in community remains to be seen. The federal Patient Self-Determination Act (PSDA), which became effective in December 1991, has spawned a rash of legislation