Federal advance directives legislation: potential effects on emergency medicine

On December 1, 1991, a new federal law designed to increase public use of advance directives takes effect. After that date, health care facilities must provide written information about advance directives to all adult patients. This information must describe (1) the patient's rights to make medical care decisions under state statutes and case law, and (2) how patients can secure these rights within the scope of the provider's policies. The law also requires that institutions educate their staffs and the communities about advance directives and document the existence of any advance directive in the patient's medical record. The new federal law will benefit American society, U.S. health care, and the practice of emergency medicine. However, emergency physicians should anticipate that the law will provide not only benefits, but also some burdens. Many institutions will expect emergency department personnel to disseminate and explain the required information, and annotate the medical record. It is the specialty's responsibility to gather empirical data that can guide the use of advance directives in emergency departments.