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What is commonly referred to as the Patient Self-Determination Act (PSDA) of 1991 was part of the Omnibus Budget Reconciliation Act of 1990 (Sections 1395cc and 1396a). A report dated August 28, 1995, by the U.S. General Accounting Office (GAO) on a study of the effectiveness of the PSDA is very interesting, if not startling. The GAO found that:

1. Health care institutions and the Department of Health and Human Services (HHS) are generally complying with most PSDA requirements;
2. Most health care providers inform patients of their right to have an advance directive, but fewer consistently document whether the patient actually received an advance directive;
3. HHS has incorporated PSDA provisions into Medicare and Medicaid provider requirements, expanded the Medicare handbook, and engaged in a limited public education campaign, but HHS has not informed Social Security recipients about advance directives as required by PSDA;
4. Only 10 to 25 percent of Americans have documented their end-of-life choices or appointed a health care agent to do so; and
5. An advance directive decision takes into consideration the availability or specificity of a living will, family wishes, physicians' attitudes, and legal issues.

Further, according to the GAO report, "In current medical practice, it is presumed that the patient wants all possible care to be provided, unless otherwise stated." A written, signed and witnessed (or notarized, as required in some locations), document detailing your specific health care instructions is the best way, and maybe the only way, to protect yourself against treatment options you will not accept. Executed properly, these documents are legally binding, and health care providers are required by law to abide by them.

In most U.S. states, this legal document is known as an Advance Medical/Health Care Directive or Durable Power of Attorney for Health Care (DPAHC). It can address your wishes regarding end-of-life decisions if you are terminally ill or are unconscious and will not regain consciousness, and instructions about health care matters, including your wishes about avoiding blood transfusions and acceptable alternatives.

Note: To gain access to Advance Directives or Durable Power of Attorney for Health Care forms consult your physician, hospital, governmental office on health care, or local library. Laws vary from state to state so be sure you are completing a document for the state in which you reside.

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Jan Graziani - LVN
Chicago, IL USA