Patient Self-Determination Act

Autonomy concerns the moral and legal rights of persons to make their own decisions including treatment preferences and other health care-related decisions. If a patient is deemed to have decision-making capacity, health care providers are not permitted to disregard that person's wishes. Furthermore, they must provide the person with the necessary information to undertake the best course of action that is consistent with personal values. The only restraints on autonomy are when the person's decisions or choices endanger another or when decision-making capacity is impaired. The Patient Self-Determination Act (PSDA) (1991) supports the right of the individual to receive adequate and accurate information to make end-of-life decisions. Patients have the right to discontinue or refuse treatments that they do not want, even if this accelerates death. However, some elderly individuals do experience constraints on their autonomy. The nurse's advocacy responsibilities include identifying the constraints and providing additional resources or information when these constraints interfere with informed decision-making.

Many ethical issues surround decision-making for elderly persons. Among these issues are: determination of decision-making capacity, determining whether consent to treatments or the refusal of unwanted treatments is truly informed, and determining whether the proxy decision maker knows the elderly patient's values and treatment preferences adequately enough to make decisions on behalf of the patient. Many elders often experience subtle pressure to make decisions that are not really what they want. The pressure can come from friends or relatives potentially affected by the particular decision, or from health care providers who feel they really do know what is in the best interests of the patient.

Effective strategies that can be used in the role of nurse advocate will depend somewhat on the degree of decision-making capacity loss experienced by the elderly person, his or her physical condition, and the family/support resources available.