Implementation and Impact of the Patient Self Determination Act: Preliminary Survey and Proposals for Change

Abstract

To promote advance medical directives, which the U.S. Supreme Court encouraged in Cruzan v. Director, Missouri Department of Health, Congress enacted the Patient Self Determination Act (PSDA). The law requires various medical facilities to inform patients of their rights under state law to execute advance medical directives. Results from in-depth interviews with hospital and nursing home administrators, however, reveal that although the law has been implemented, it is having little practical effect on patients and residents. Other requirements of the law also are being carried out with different amounts of energy. A different orientation for policymakers, medical institutions, and adult consumers to the right to die may be more effective than the current law.