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Case Study The Patient Self-Determination Act (PSD

Case Study The Patient Self-Determination Act (PSDA) was passed as part of the Omnibus Budget Reconciliation Act of 1990. The law requires all health-care facilities receiving reimbursement from Medicare and Medicaid to ask individuals, on admission, if they have an advance directive. The law requires that individuals be given written information explaining advance directive documents if they so choose and the opportunity to create an advanced directive. Since 1990, research regarding the role ethnicity plays in end-of-life decisions has been conducted. This research shows that regardless of the specific ethnicity, members of minority groups are generally less desirous of completing advance directives than are whites. The research suggests that end-of-life choices are more related to race, ethnicity, and culture than to age, education, or socioeconomic status. Barriers made by the law that surfaced during the research are that (1) the PSDA is based on written communication and assumes all clients can read and write; (2) there is the assumption that clients will trust the medical community to make every possible attempt to save a life before “pulling the plug,” but not all clients hold that belief; and (3) the law assumes that personal choice is of higher importance than family or communal choice. Areas to Analyze: 1. Describe the conflicts surfaced by this law related to cultural differences. 2. Analyze what you might do as a health-care professional to “bridge the gap” in cultural communications related to end-of-life issues. 3. Explain how you think it should be handled when the family disagrees with the Advance Directive and “wants everything done”. 4. Analyze your reasons for completing or not completing your own advanced directives.

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