Patient Self-Determination Act

Providers Offer Information on Advance Directives but Effectiveness Uncertain Gao ID: HEHS-95-135 August 28, 1995

Congress passed the Patient Self-Determination Act in 1990 to reinforce individuals' constitutional right to decide their final health care. The act requires health care providers to increase public awareness about the use of "advance directives"--a living will or health care power of attorney. An advance directive spells out how life-support decisions should be carried out should the patient become terminally ill and unable to communicate his or her wishes. This report provides information on the act's implementation and on the effectiveness of advance directives in ensuring patient self-determination. GAO looks at the extent to which (1) institutional health care providers and the federal government are complying with the act's provision, (2) the public uses advance directives to express their end-of-life treatment wishes, and (3) an advance directive affects a patient's desired care.

GAO found that: (1) health care institutions and the Department of Health and Human Services (HHS) are generally complying with most PSDA requirements; (2) most health care providers inform patients of their right to have an advance directive, but fewer consistently document whether the patient actually received an advance directive; (3) HHS has incorporated PSDA provisions into Medicare and Medicaid provider requirements, expanded the Medicare handbook, and engaged in a limited public education campaign, but HHS has not informed Social Security recipients about advance directives as required by PSDA; (4) only 10 to 25 percent of Americans have documented their end-of-life choices or appointed a health care agent to do so; and (5) an advance directive decision takes into consideration the availability or specificity of a living will, family wishes, physicians' attitudes, and legal issues.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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