Legal Implications of Advance
Directives and No-Code Orders
[Advances in medical knowledge and the development of life-sustaining technologies have changed the very nature of death. No longer a 'moment', dying may now be viewed as a process or continuum, the duration of which can be prolonged indefinitely. This technological potential has given rise to an unprecedented array of professional, moral, and legal questions within the health care delivery system] (Schwarz 1992, 92). The nursing profession has now become intimately involved in the protocols of death. There is even a nursing diagnosis for it: [Dying Process].
The rights of a terminally ill person to refuse medical intervention of any kind have not always been clear. Two legal landmark cases (Quinlan in 1976 and Cruzan in 1990) focused widespread interest on the legal and ethical implications of the [right to die] issue. On December 1, 1991, the Patient Self-Determination Act of 1990 (PSDA, the Act) went into effect in the United States. This statute confirmed the immemorial common law principle that every competent human being who has reached majority has an inherent right to accept or refuse medical treatment—the concept affirmed by Justice Cardozo over eight decades ago. It is in dealing with the incapacitated or incompetent adult in need of medical intervention that at