Therapeutic Jurisprudence and End-of-Life Medical Care: Physician Perceptions of a Statute's Impact Medical Law 15 Medicine and Law 1996

15 Med. & L. 201 (1996)
Therapeutic Jurisprudence and End-of-Life Medical Care: Physician Perceptions of a Statute's Impact

handle is hein.journals/mlv15 and id is 213 raw text is:

Med Law (1996) 15:201-217 Medicine
and Law
Medical Law o YozMon 196

THERAPEUTIC JURISPRUDENCE AND END-OF-LIFE MEDICAL
CARE: PHYSICIAN PERCEPTIONS OF A STATUTE'S IMPACT

Marshall B. Kapp, J.D., M.P.H. Departments of Community Health and
Psychiatry, Office of Geriatric Medicine & Gerontology, Wright State
University School of Medicine.

Abstract Objective: Assess the perceptions of Ohio physicians
regarding the impact of their state's 1990 advance directive legislation
on their medical practices when decisions need to be made and
implemented concerning use of life-prolonging medical interventions,
and to draw public policy.
Design: A mailed survey to physicians, to be completed and returned
anonymously. The form contained ten questions to be answered
according to a five-point Likert scale, a request for demographic
information, and an opportunity to write additional comments on the
form.
Setting: Surveys mailed to every physician on the Wright State
University continuing medical education mailing list who had
designated a specialty in internal medicine, family practice, or surgery.
Main Outcome Measures: Physicians' perceptions of the impact of
Ohio's advance directive legislation on their communication with
patients and families, anxieties about legal liability associated with end-
of-life care, and willingness to limit life-prolonging medical
interventions in specific situations.
Results: Mixed. While many physicians reported enhancements in
relationships, communication, and willingness to respect patient and
family wishes due to the statute, others reported an opposite effect. For
many physicians, the statute made little impact on their practices.
Conclusions: The Ohio statute could benefit from rewriting, but there
are inherent problems with advance directive laws. Professional
education about death and dying issues and the chance for physicians to
practice end-of-life treatment techniques are essential.
American society has a long and natural tradition of responding to
difficult social problems with legal interventions. Much energy has been
devoted in the past decade, especially in response to the United States
Supreme Court's decision in the Cruzan case,' by Congress and the various
state legislatures to debating and enacting statutes regarding the ethics of
medical care near the end of life. The resulting federal Patient Self -
Determination Act (PSDA),2 implementing regulations, and panoply of state
statutes have as their chief objectives siaking both members of the public and

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