Advance Medical Directives in U.S. Hospitals and Nursing Homes: The Implementation and Impact of the Patient Self-Determination Act

In 1990, the U.S. Supreme Court endorsed living wills and other written advance medical directives as the best way for people to indicate their desires regarding end-of-life medical treatment. Congress then enacted the Patient Self-Determination Act (PSDA), which requires most medical facilities to provide information about advance medical directives. However, results from a national survey of hospital and nursing home administrators reveal that the law is having little practical effect on patients and residents. Medical institutions need to institutionalize a more positive approach to advance directives, but other right-to-die policies are also needed.