Advance Directives on Admission: Clinical Implications and Analysis of the Patient Self-Determination Act of 1990
La Puma, John
Moss, Robert J.
JAMA. 1991 Jul 17; 266(3): 402-405.
To encourage patients to complete advance directives, Congress enacted the Patient Self-Determination Act...last October. The Act takes effect on December 1, 1991, and requires hospitals, nursing homes, and hospices to advise patients on admission of their right to accept or refuse medical care and to execute an advance directive. Managed care organizations and home health care agencies must provide the same information to each of their members on members' enrollment. Provider organizations will also be required to (1) document whether patients have advance directives, (2) implement advance directive policies, and (3) educate their staffs and communities about advance directives. Compliance with the Act is a condition for Medicare and Medicaid reimbursement and is tied to institutional Medicare contracts....Compliance with the Act raises clinical, legal, financial, and ethical problems. Our purpose herein is to review the empirical data on advance directives, identify potential benefits of and likely barriers to the Act's successful implementation, and suggest ways in which patients, providers, and physicians might best take advantage of the new requirements.
Advance Directives; Allowing to Die; Attitudes; Autonomy; Communication; Comprehension; Consent Forms; Contracts; Consent; Decision Making; Economics; Evaluation; Evaluation Studies; Federal Government; Forms; Government; Health; Health Care; Health Facilities; Hospices; Hospitals; Information Dissemination; Institutional Policies; Legal Aspects; Legislation; Life; Living Wills; Mandatory Programs; Managed Care; Nursing Homes; Organizations; Patient Admission; Patient Participation; Patients; Physicians; Policy Analysis; Prolongation of Life; Psychological Stress; Resuscitation; Resuscitation Orders; Review; State Government; Statistics; Third Party Consent; Withholding Treatment; Wills;
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