Any Truth In Psychological Explanations?

recognized. How have we come to a crossroads where federal legislation is enacted to protect citizens from their physicians? Will physicians resent the Patient Self-Determination Act for this reason? How are other fundamental principles of medical ethics--beneficence, nonmaleficence, and justice-factored into this new legal equation for medical decision making? Difficult decisions at the margins of life remain the most sensitive issues we face as physicians, individuals, and a society. There are no clearly correct answers. The ideal advance directive does not exist. As noted by Seckler, et a1. we need a new "standard which promotes trust between patients and their caregivers (both family and professional) and would return to a recognition that not all of life's events can or should be anticipated." 6 This new standard must recognize the limits of medical knowledge and human foresight. It must combine best-interest considerations, surrogate decision making, and written advance directives. Research into patterns of communication and decision making will bring clarity to the debate. Family physicians must begin to act now within the new requirements of the Patient Self-Determination Act to find techniques that are effective for them and their patients. This act is an important, though imperfect beginning. We must not allow it to become a "medical Miranda warning" .. distorting our best traditions of helping and healing. Glenn Rodriguez, M.D. John Saultz, M.D. Portland, OR