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July 17, 1991

The Patient Self-Determination ActOn Balance, More Help Than Hindrance

JAMA. 1991;266(3):410-412. doi:10.1001/jama.1991.03470030110035

The Patient Self-Determination Act (hereafter, the Act), which takes effect on December 1,1991, creates no new rights for patients or for citizens generally. The law requires Medicare/Medicaid-receiving health care providers to inform patients of their existing rights under state law to refuse treatment and prepare advance directives. By doing so, it merely affirms principles that have their roots in both common law and constitutional law dating back to the late 19th century. ("[N]o right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his person, free from all restraint or interference of others, unless by clear and unquestionable authority of law."1) Legal and ethical principles that govern decision making about medical treatment, familiar to most clinicians as the doctrine of informed consent, have played a significant role in clinical decision making for decades