The Patient Self-Determination Act of 1990 requires health care facilities to provide information to patients about their rights to make decisions about their own health care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. The Act also requires health care facilities to document whether or not a patient has an advance directive. Advance directives are written instructions, such as a living will or durable power of attorney for health care, that indicate a patient’s wishes regarding medical treatment in the event they are unable to make decisions for themselves.

Patient Self-Determination Act

US law

The Patient Self-Determination Act (PSDA) was approved by the United States Congress in 1990 as an amendment to the Omnibus Budget Reconciliation Act of 1990. Effective December 1, 1991, this legislation required many hospitals, asylum, home health agencies, hospice Providers, health maintenance organizations (HMOs) and other healthcare institutions to provide information about advance health directives for adult patients after their admission to the health facility. This law does not apply to individuals doctors.

As the 1991 PSDA does not apply to individual physicians, clinics and private practices, most of which are incorporated for-profit organizations, the problem of for-profit cruel treatment of seniors in Medicare/Medicaid has not been brought under control to the extent that the Congress hoped would be possible when states implemented the 1991 PSDA goals into state law. (In 2012, newspapers[which?] revealed that the US Department of Health and Human Services and the Department of Justice cooperated to prosecute the treatment of patients under the federal False Claims Act.) The objectives of the 1991 PSDA are discussed in the “Purpose” section below.

Section 1233 of the proposal America’s Affordable Health Choices Act of 2009 (HR 3200) would have authorized reimbursements for medical advice on advance directives (once every five years), but was not included in the Patient Protection and Affordable Care Act 2010 because of controversy over what was characterized as “death panels.”

Unfortunately, as the 1991 PSDA Act does not require or oblige treating physicians – after an instructed “terminal” prognosis is shared with the patient – to seek informed consent from Medicare/Medicaid elderly and terminally ill patients for curative care under the Medicare or palliative care, transition to Hospice in the last six months of life (also paid from the Medicare grant), PSDA goals are not met. Patient self-rationing of expensive end-of-life medical care through the advance directive process under the 1991 PSDA provisions is discouraged because patients have not had end-of-life conversations with their treating physicians.


The PSDA requirements are as follows:

  • Patients receive written notice upon admission to the healthcare facility of their decision-making rights and policies regarding advance healthcare directives in their state and the facility to which they are admitted. Patient rights include:
  1. The right to facilitate your own health care decisions
  2. The right to accept or refuse medical treatment
  3. The right to make an advance health care directive
  • Institutions should ask if the patient already has an advance health care directive and note this in their medical records.
  • Facilities must provide education to their employees and affiliates about advance health care directives.
  • Health care providers are not authorized to admit or treat patients in a discriminatory manner based on whether or not they have an advance health care directive.


The purpose of the Patient Self-Determination Act was/is to inform patients of their rights in relation to decisions about their own medical care and to ensure that these rights are communicated by the healthcare provider. Specifically, the rights afforded are the patient’s to dictate their future care (by means such as living will or letter of attorney), if they become incapacitated.

The “purpose” objectives of the Patient Self-Determination Act are/were (1) to prevent the cruel treatment of elderly/disabled Medicare/Medicaid patients for the profit motive and (2) to save money for Medicare and private insurers in the form of reduced end-of-life costs for Medicare and private insurers when elderly Medicare/Medicaid patients ELECT/CHOOSE to decline expensive ICU/CC treatments. extending or saving treatments in the hospital in order to shorten their suffering until certain death. It was envisioned by the creators of the 1991 PSDA that the elderly/disabled on Medicare/Medicaid would die cheaper and more comfortably (without pain) in palliative care/hospice Medicare Right in their own personal residence or in the setting of a residential nursing home when attending physicians consulted them about their terminal diagnoses.


Further reading

External Links

Source: Patient Self-Determination Act

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