PATIENT SELF-DETERMINATION AND THE ARTIFICIAL PROLONGATION OF LIFE

Ethical dilemmas are inherent in health care decision making. The Pati ent Self-Determination Act of 1990 provides health care facilities wit h guidelines to address patients' advance directives. Family members w ho are charged with the responsibility to implement their loved ones' wishes often feel emotional conflicts because of the many difficulties that arise from making life and death decisions for another person. T he PRACTICE model discussed in this article allows health care practit ioners to think about ethical issues in a structured and systematic wa y. Social workers have a vital role to play in facilitating the implem entation of patients' advance directives by working with the patient i n creating clear and accurate directives, by supporting the family in allowing these directives to be carried out, and by working with the t reatment team to resolve ethical dilemmas.