Patient Autonomy

Question 1

What is the point of Cruzan v. Director?

Answer 1

The main holding of the Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990), is that a state may require “clear and convincing evidence” of an incompetent individual’s desire to withdraw life-sustaining treatment before family members can terminate life support for that individual. This decision affirmed the right of a competent person to refuse medical treatment under the Due Process Clause of the Fourteenth Amendment but established that for an incompetent person, the state can impose a higher evidentiary standard to ensure that the decision reflects the patient’s wishes.

Question 2

Elements of Informed Consent?

Answer 2

1. Information is provided to patient about risks, alternatives, and likely outcome if procedure not performed
2. Patient is sufficiently competent to understand the risks and likely outcomes
3. Actual consent to treatment

Question 3

When is informed consent not required?

Answer 3

Emergency or therapeutic privilege

Question 4

Is the right to refuse treatment constitutional?

Answer 4

Yes, under right to privacy (state constitutions, state and federal appellate courts) and liberty interest under due process clause of 14th amendment (Supreme Court- Cruzan case)

Question 5

What is the standard of evidence needed to establish a patient wishes?

Answer 5

Clear and convincing, possibly in writing

Question 6

What is the Patient Self Determination Act?

Answer 6

1990 Federal law requiring health providers that take medicare/Medicaid to notify patients of their right to make medical treatment decisions. Patients are not required to sign directives.