Patient Self-Determination Act

Patient Self-Determination Act

The Patient Self-Determination Act (PSDA) is a significant piece of legislation in the United States that was enacted in 1990 as part of the Omnibus Budget Reconciliation Act. It mandates that healthcare providers, including hospitals, nursing homes, healthcare agencies, and hospice providers, receiving federal funds through Medicare and Medicaid programs, must inform patients of their rights to make decisions concerning their medical care. This includes the right to accept or refuse medical or surgical treatment and the right to prepare an Advance Directive. The PSDA underscores the importance of patient autonomy in healthcare decision-making and aims to increase awareness and utilization of advance directives.

Background

The movement towards recognizing and ensuring patient autonomy in healthcare decisions gained momentum in the late 20th century, with increasing attention to the rights of patients to dictate their end-of-life care. Prior to the enactment of the PSDA, individuals often received medical treatments that they might not have wanted, simply because they were unable to communicate their wishes and had not prepared an advance directive. The PSDA was introduced to empower patients, ensuring that they are informed of their rights to make critical healthcare decisions ahead of time.

Provisions

The PSDA contains several key provisions:

• Healthcare providers must give adult patients written information about their rights under state law to make decisions concerning their medical care, including the right to accept or refuse treatment and the right to formulate advance directives.
• Institutions must inquire and document in the patient's medical record whether the patient has an advance directive.
• Healthcare providers are prohibited from discriminating against patients based on whether they have an advance directive.
• The act requires institutions to provide education for staff and the community on issues related to advance directives.
• Healthcare facilities are required to have policies and procedures in place regarding the implementation of these rights.

Impact

The implementation of the PSDA has led to increased discussion between patients and healthcare providers about end-of-life care and advance directives. It has encouraged more individuals to express their wishes regarding medical treatment in advance, potentially reducing the number of people receiving unwanted medical interventions. However, despite its intentions, studies have shown that the prevalence of advance directives has not increased as significantly as expected, indicating ongoing challenges in promoting their use among patients.

Advance Directives

Advance directives are legal documents that allow individuals to convey their decisions about end-of-life care ahead of time. They provide a way for patients to communicate their wishes to family, friends, and healthcare professionals, and to avoid confusion later on when they may no longer be able to communicate their wishes. There are two main types of advance directives: the Living Will and the Durable Power of Attorney for Health Care.

Conclusion

The Patient Self-Determination Act represents a crucial step in recognizing and respecting patient autonomy in healthcare decisions. By ensuring that patients are informed of their rights and have the opportunity to express their wishes regarding medical treatment, the PSDA promotes a more patient-centered approach to healthcare. Despite its challenges, the act has had a lasting impact on the relationship between patients and healthcare providers, emphasizing the importance of communication and advance planning in medical care.