Complying with the Patient Self-Determination Act: legal, ethical, and practical challenges for hospitals

On 1 December 1991, the Patient Self-Determination Act became law. This Act requires certain health care providers to distribute information to patients concerning advance directives (i.e., living wills and health care power of attorney). The information must include a statement of an individual's rights under the law of the state where the care is being provided. In fact, the provider must actually promulgate written policies and procedures regarding compliance with the Act. The entire law is only a few paragraphs of legislation, and yet its legal, ethical, and practical effect for the health care provider is broad. This article is designed to discuss why the Act was promulgated, what its provisions are, how to comply with it, and what can occur if a health care provider fails to comply.