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The States as Laboratories: Regulation of Decisions for Incapacitated Patients
Erin S DeMartino1, Joshua A Rolnick2
1Mayo Clinic, Rochester, New York USA. demartino.erin@mayo.edu.
The Journal of Clinical Ethics
|June 13, 2019
Summary
State laws in the US for medical decision-making vary significantly. This review examines advance directives, physician orders for life-sustaining therapies (POLST), and surrogate laws, highlighting current challenges and future reform needs.
Area of Science:
- Medical Law
- Bioethics
- Health Policy
Background:
- Patient autonomy is central to medical decision-making.
- When patients lose decision-making capacity, legal frameworks dictate care.
- Existing laws for advance directives and surrogate decision-making differ across US states.
Purpose of the Study:
- To analyze the legal landscape of medical decision-making for incapacitated patients in the US.
- To describe current practices and challenges in applying these laws.
- To identify areas for future research and legislative reform.
Main Methods:
- Historical tracing of relevant state laws.
- Review of current legal statutes and case law.
- Analysis of practical application and ethical considerations.
Main Results:
- Significant jurisdictional variation exists in laws governing advance directives, physician orders for life-sustaining therapies (POLST), and surrogate appointments.
- Current practices face challenges in consistent application, leading to potential disparities in patient care.
- Gaps in legislation and implementation necessitate further ethical and legal examination.
Conclusions:
- Understanding state-specific laws is crucial for healthcare providers and patients.
- Legislative reform is needed to ensure equitable and consistent application of patient-centered care principles.
- Further research should focus on improving the efficacy and accessibility of end-of-life decision-making tools.
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