The Patient Self-Determination Act: new responsibilities for health care providers

On December 1, 1991, most health care provider organizations became subject to the portions of The Omnibus Budget Reconciliation Act of 1990 informally known as the Patient Self-Determination Act (PSDA). This law does not create new substantive rights but instead requires providers to inform patients of their existing rights under state law to make health care decisions and to execute "advance directives," such as durable powers of attorney for health care and living wills. The PSDA could end up as just one more federal bureaucratic intrusion into health care that increases its cost while enhancing neither its effectiveness nor its humanism. A better outcome is possible only if providers treat it as an opportunity to work with their staff (including attending physicians) to enhance the quality of patient decisionmaking and planning for future illness, so that the real discussions needed to create useful advance directives can go on among patients, their family members, and the health care professionals who care for them.