Sources of Concern about the Patient Self-Determination Act

ON December 1, 1991, the Patient Self-Determination Act of 1990 (PSDA) 1 went into effect. This is the first federal statute to focus on advance directives and the right of adults to refuse life-sustaining treatment. The law applies to all health care institutions receiving Medicare or Medicaid funds, including hospitals, skilled-nursing facilities, hospices, home health and personal care agencies, and health maintenance organizations (HMOs). The statute requires that the institution provide written information to each adult patient on admission (in the case of hospitals or skilled-nursing facilities), enrollment (HMOs), first receipt of care (hospices), or before the patient comes under an . . .