Advance Directives - The Patient Self-determination Act

In 1990 Congress enacted the Patient Self-Determination Act (PSDA) as part of the Omnibus Budget Reconciliation Act of 1990 (PL 101-508). This legislation was intended to "reinforce individuals' constitutional right to determine their final health care."

The PSDA took effect on December 1,1991. It requires all health care providers participating in Medicare (a program of the federal government through which people age sixty-five and older receive health insurance) and Medicaid (a program run by the federal and state governments to provide health insurance to people younger than sixty-five years of age who cannot afford to pay for private health insurance) to provide all patients over age eighteen with the following written information:

• The patient's rights under the law to participate in decisions about his or her medical care, including the right to accept or refuse treatments
• The patient's right under state law to complete advance directives, which will be documented in his or her medical records
• The health care provider's policies honoring these rights

Providers include hospitals, nursing homes, home health care providers, hospices, and health maintenance organizations (HMOs), but not outpatient-service providers or emergency medical personnel. The PSDA requires health care providers to educate their staff and the community about advance directives. It also prohibits hospital personnel from discriminating against patients based on whether they have an advance directive. (Patients are informed that having an advance directive is not a prerequisite to receiving medical care.)