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Advance Directives on Admission Clinical Implications and Analysis of the Patient Self-Determination Act of 1990

John La Puma, MD; David Orentlicher, MD, JD; Robert J. Moss, MD
JAMA. 1991;266(3):402-405. doi:10.1001/jama.1991.03470030102032.
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DESPITE widespread acknowledgment of the need for individuals to draft living wills, durable powers of attorney, or other advance directives, few Americans have done so. To encourage patients to complete advance directives, Congress enacted the Patient Self-Determination Act (hereafter "the Act") last October. The Act takes effect on December 1,1991, and requires hospitals, nursing homes, and hospices to advise patients on admission of their right to accept or refuse medical care and to execute an advance directive. Managed care organizations and home health care agencies must provide the same information to each of their members on members' enrollment. Provider organizations will also be required to (1) document whether patients have advance directives, (2) implement advance directive policies, and (3) educate their staffs and communities about advance directives. Compliance with the Act is a condition for Medicare and Medicaid reimbursement and is tied to institutional


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