Sources of Concern about the Patient Self-Determination Act

Advance directives have provoked a number of reservations. As the [Patient Self-Determination Act] goes into effect, requiring discussion implementation of directives, it will be essential to address physicians' reservations as they arise. Yet that necessary step will not be to ensure that the PSDA produces more benefit than harm. There is risk that written advance directives may wrongly come to be viewed as the way to make treatment decisions for the future. Physicians and other givers may improperly begin to require an advance directive before may be forgone for incompetent patients. To avoid this, staff must include discussion of the various ways to decide about-sustaining treatment and plan future care. Even under the PSDA, not all will use advance directives. There is a further risk of confusion the procedures and materials to use in implementing the PSDA. All in the relevant institutions will need clarification of the-by-step process to be followed with patients, the written materials to, and how to resolve specific questions. The information conveyed to must be understandable, accurate in summarizing the patient's rights, sensitively communicated. All staff members who are involved must be. Institutions must design appropriate protocols. Finally, there is a that the PSDA will reduce the discussion of treatment options and to a bureaucratic process dominated by brochures and forms. To this, the discussion of advance directives must be part of an ongoing between physician and patient about the patient's health status and....