A mentally competent individual has a Constitutional right to determine the kind of medical treatment he or she will receive. The individual may also decide what type of treatment he or she will NOT receive. These rights were confirmed by the United States Supreme Court in the Cruzan case, which was decided in 1990.

Congress Enacts the Patient Self-Determination Act

The Patient Self-Determination Act was enacted in 1991. The PSDA, a reaction to the Cruzan case, is a modest step toward the goal of having our Constitutional right of medical self-determination respected.

The PSDA merely requires health care facilities to ask, when you are being admitted, if you have an advance directive.


  • does NOT require the health care facility to prepare the document or guide you in its preparation
  • does NOT require the health care facility to look for your advance directive
  • does NOT require the hospital or nursing home to keep your advance directive in your medical chart
  • does NOT describe a model advance directive that will be respected in every state

How Effective Is the Patient Self-Determination Act?

A 1995 Government Accounting Office study estimates that
only 10-25%
of the adult population has completed an advance directive.

This GAO study suggests that:

  • physicians are not discussing with their patients the need for an advance directive
  • discussing the advance directive in the course of hospital or nursing home admission is ineffective because the newly-admitted patients are usually very ill or upset. This is not a good time to discuss advance directive issues.
  • many physicians incorrectly believe that advance directives are only for old people (Nancy Cruzan was about 25; Karen Quinlan was also young). One author suggests that high school students be taught about advance directives.

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