Patient Self-Determination Act:

Providers Offer Information on Advance Directives but Effectiveness Uncertain

HEHS-95-135: Published: Aug 28, 1995. Publicly Released: Aug 28, 1995.

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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.

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.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: The Department of Health and Human Services cannot implement a mass mailing to all Social Security beneficiaries due to the enormous expense involved.

    Recommendation: The Secretary of Health and Human Services should analyze whether a mailing about advance directives to Social Security recipients would be a cost-effective way of further meeting the needs addressed by Congress in PSDA and, if not, seek a legislative amendment repealing the requirement.

    Agency Affected: Department of Health and Human Services


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