Patient self-determination and the artificial prolongation of life.

Ethical dilemmas are inherent in health care decision making. The Patient Self-Determination Act of 1990 provides health care facilities with guidelines to address patients' advance directives. Family members who are charged with the responsibility to implement their loved ones' wishes often feel emotional conflicts because of the many difficulties that arise from making life and death decisions for another person. The PRACTICE model discussed in this article allows health care practitioners to think about ethical issues in a structured and systematic way. Social workers have a vital role to play in facilitating the implementation of patients' advance directives by working with the patient in creating clear and accurate directives, by supporting the family in allowing these directives to be carried out, and by working with the treatment team to resolve ethical dilemmas.