The Maladaptation of Miranda to Advance Directives: A Critique of the Implementation of the Patient Self-Determination Act

In this Article, Thaddeus Pope argues that the Patient Self Determination Act (PSDA) is a failure on its own terms. The Article first identifiesthe central purpose of the Act as the protection of patient autonomy. The Article then reviews much of the empirical research on the implementation of the Act. This research suggests that the medical preferences expressed in advance directives completed pursuant to the PSDA are usually not based on real understanding because patients are merely Mirandized of their right to direct their post-autonomous medical care. Although some scholars contend that this is the most that can be expected of the PSDA, Mr. Pope argues that patient autonomy is not an impossible goal. The Article concludes that patient autonomy can still be protected if advance directives are completed with adequate informed consent