These include hospitals, nursing homes, home health care providers, hospices, and health maintenance organizations, but not providers of outpatient services or emergency medical teams.Specifically, the provider or organization is required to provide to all adult patients, residents, and enrollees written information on their rights under state law to make decisions concerning medical care, including the right to execute an advance directive, as well as maintain the policies of the provider regarding implementation of advance directives; document in the medical record whether the individual has an advance educate the staff and the community about advance directives; not condition the provision of care, or otherwise discriminate, on the basis of whether a patient has an advance directive; and ensure compliance with state law respecting advance directives. In addition, PSDA requires that HHS conduct a public education campaign about advance directives and oversee provider compliance. HHS, through the Health Care Financing Administration (HCFA), has complied with most PSDA provisions. Limited Information Suggests That Institutions Comply With Most Requirements

Under PSDA, Medicare and Medicaid hospitals, nursing facilities, and other providers must inform patients of their decision-making rights, distribute state-specific information about advance directives, and inquire and document whether a patient has an advance directive. A variety of factors affects whether an advance directive actually controls end-of-life care decisions, including the availability or specificity of a living will, family wishes, physicians’ attitudes, and legal issues. We are sending copies of this report to the Secretary of Health and Human Services, interested congressional committees, and others. 4.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on the implementation of the Patient Self-Determination Act (PSDA), and the effectiveness of advance directives in ensuring a patient's desired care.

What GAO Found

GAO found that: (1) health care institutions and the Department of Health and Human Services (HHS) are generally complying with most PSDA requirements; (2) most health care providers inform patients of their right to have an advance directive, but fewer consistently document whether the patient actually received an advance directive; (3) HHS has incorporated PSDA provisions into Medicare and Medicaid provider requirements, expanded the Medicare handbook, and engaged in a limited public education campaign, but HHS has not informed Social Security recipients about advance directives as required by PSDA; (4) only 10 to 25 percent of Americans have documented their end-of-life choices or appointed a health care agent to do so; and (5) an advance directive decision takes into consideration the availability or specificity of a living will, family wishes, physicians' attitudes, and legal issues.