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The goal of the PSDA is to foster communication between patients and physicians about patients' preferences for life-sustaining therapies. Compliance with the PSDA is a condition for reimbursement by Medicaid and Medicare. General hospital psychiatry units are covered by the PSDA, yet compliance may pose both ethical and clinical problems for psychiatrists working in this setting. Is the PSDA appropriate for newly admitted psychiatric patients? We have narrowed the focus of this article to elderly patients admitted to the hospital for treatment of depression. We have chosen to focus on depressed elderly patients because the elderly are, in large measure, the main target of the PSDA. In addition, elderly persons with depressive disorders constitute a substantial and increasing proportion of new admissions to general hospital psychiatry units.
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Ganzini et al. (1993) studied this question.
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