Implications of the Patient Self-Determination Act for psychiatric practice.

The U.S. Congress enacted the Patient Self-Determination Act in the wake of the Supreme Court's 1990 decision in the case of Nancy Cruzan, which concerned discontinuing life-sustaining medical treatment for a decisionally incapacitated patient. This statute attempts to promote individual autonomy in medical decision making, particularly concerning life-sustaining medical treatments; it imposes specific requirements on organizational health care providers to encourage patients to plan ahead for health care contingencies by executing advance directives such as living wills and durable powers of attorney. The author discusses the ethical principles and public policy considerations undergirding the act and the advance directive movement in general and explores the implications of the act for current and future psychiatric practice in the U.S.