Abstract
Conclusion: The PSDA [Patient Self-Determination Act] is a welcome development for nursing facilities, as well as residents and families. For years, many residents, families, and facilities have not confronted the issue of end-of-life treatment decisions. The result has been a "double blind" situation for all concerned. Few residents enter a nursing facility having written advance directives, and many have never discussed their treatment wishes with family members. At the same time, nursing facilities have failed to alert entering residents to facility policies concerning requests to receive (or forgo) treatment at the end of life. In fact, some facilities have never developed written policies. Implementation of the PSDA will create dramatic changes in the way many nursing facilities address the subject of advance directives with their residents. It is hoped that these changes will help patients and residents communicate their treatment wishes more comfortably and with confidence that their decisions will be carried out. In addition, providers will have greater assurance that they understand the resident's wishes if and when certain treatment contingencies occur....
