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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