Rights of Patients for Self-determination


The U.S. Supreme Court recognized the constitutional right of self determination with regard to refusing life-sustaining medical treatment In Cruzan v. Commissioner, Missouri Department of Health, 497 U.S. 261 (1990). The decision required the hospital to honor the family's demand to remove life support from Nancy Cruzan. Nancy Cruzan was victim of an automobile accident and had languish in an irreversible coma for nine years.

On December 1 1991, the U.S. Congressional Patient Self-determination Act (PSDA) took effect. The PSDA requires Medicare and Medicaid providers (such as hospitals, nursing homes, hospices, home health agencies, and HMOs) to give adults information, at the time of admission, about their rights under state laws. The information includes the patient's rights regarding advance directives, as well as the right to accept or refuse medical or surgical treatment.

The act also prohibits an institution from discriminating against a patient who does not have or want an advance directive.
If the patient is a minor or is incapacitated, these rights extend to the patient's representative. The decisions that patients, or their representatives, make may not always coincide with the advice of healthcare providers, but those decisions need to be respected.


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