Patient Self-Determination Act of 1991 (PSDA)

Notes

• Passed in 1990 largely as a result of the Missourd State Supreme Court ruling in the case of Nancy Cruzan, a woman in permanent coma after a motor-vehicle accident whose parents attempted to have life-sustaining treatment withdrawn. The court ruled that there must be clear & convincing evidence of a patient's wishes to withdraw care
• requires hospitals, skilled nursing facilities, home health organizations & Health Maintenance Organizations to
  • provide written information about each individual's rights to make decisions concerning their medical care & how the institution implements those rights
  • document in the medical record whether or not the person has executed an advance directive
  • ensure compliance with state law regarding respecting advance directives
  • provide education for staff & community concerning advance directives
• applies only to those health care organizations that participate in Medicare & Medicaid
• studies suggest PSDA has done little to improve clinical care with regards to advance directives completion or end of life treatments patients receive

More general terms

• medical ethics