12 Dev. Mental Health L. 1 (1992)

handle is hein.journals/dvmnhlt12 and id is 1 raw text is: Developments in
Mental Health Law
Institute of Law, Psychiatry and Public Policy - The University of Virginia
Volume 12, Number 1                                                          January - June 1992
Patient Decisions and Psychiatric Hospitals: Quandaries of the
Patient Self Determination Act
by Bethany Spielman, Ph.D., J.D.
The Patient Self Determination Act (PSDA)1 went into effect on December 1,1991. The Act includes an
informational requirement mandating that, upon admission to a hospital, nursing home, or hospice, or upon
enrollment in a health maintenance organization receiving Medicare or Medicaid funds, patients must be
informed of their right to refuse treatment and to formulate a living will or appoint a health care proxy. The
Act's purpose, in part, was to increase the number of people who exercise their rights to execute an advance
directive and refuse medical care.
Among those who may choose to exercise that right are the thirty-two million Americans who suffer each
year from a diagnosable mental disorder. One and one-half million have a chronically disabling mental illness
such as schizophrenia, other psychoses, or severe alcoholism.
The Patient Self Determination Act and Psychiatric Facilities

The threshold question regarding the PSDA in
mental health contexts is: does it apply to them at
all? The answer requires an examination of the Act's
text and legislative history. The text of the PSDA
says it is to be applied to hospitals, nursing facilities,
home health or personal service providers, hos-
pices, health maintenance organizations, and other
prepaid agencies. Therefore it does apply to psychi-
atric facilities if the term hospitals (or other eli-
gible organizations) includes psychiatric facilities.
Psychiatric facilities are
not specifically mentioned
anywhere in the text of the
Act or in its legislative his-           Also i
tory. There is no indication
that Congress intended        In the U.S. Supremt
psychiatric hospitals to be
included, butnoindication     In the Federal Cou

that it meant them to be excluded, either. It is
reasonable to conclude psychiatric facilities are cov-
ered by the Act.
The Act states that a provider must give written
information to each individual concerning rights
under state law to make decisions concerning medi-
cal care. The PSDA is intended to enhance the
right to accept or to refuse medical or surgical treat-
ment, and that phrase appears both in the text and
also regularly in the legislative history of the Act.
Senator Danforth,
who sponsored the
original bill, appar-
is issue:                 ently had in mind
Cruzan-like cases in-
urt                4      volving termination of
life sustaining medical
6      treatment. When he
introduced the bill,
9      Nancy Cruzan lay in a
persistent vegetative
state, supported by

n ti

Cases from other States

Bethany Spielman is a 1992
graduate of the University of
Virginia School of Law.

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