In all health care settings, it is helpful to have what is called an advanced directive for health care. An advanced directive contains an individual's instructions about what he wants to be done with regard to future medical care, treatments and procedures, if he is later unable to speak or communicate his wishes on his own. This document should be prepared with the assistance of an attorney for the best protections.

The Patient Self-Determination Act of 1990 (Public Law 101-508, Section 4206 and 4751) was enacted November 5, 1990, as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90). "Patient self-determination" refers to the right of competent adults to make their own medical treatment decisions, and includes the right to complete advance directives, saying how and/or by whom decisions should be made in the future in the event the person becomes incapacitated and unable to make his or her own decisions.

According to the OBRA '90, at the time of admission to a Hospice the following must happen:

• The facility must provide the patient written information concerning the patient's rights under state law to participate in decisions concerning medical care, including the right to accept or refuse medical or surgical treatment, the right to formulate advance directives;
• The facility must provide a written statement of its policy regarding implementation of these rights;
• The facility must document in its records whether the patient has executed an advance directive. Note: the facility is not required to provide advance directives to patients;
• The facility is forbidden to discriminate in the provision of medical care on the basis of whether a patient has or has not executed an advance directive;
• The facility is required to comply with all state laws regarding advance directives; and
• The facility must provide for staff and community education on issues related to advance directives.

Hospitals, nursing homes and hospices may have standard forms available which specify whether or not the patient wishes to be resuscitated in the event of a cardiac or respiratory arrest, and sometimes the patient can specify that they do not want such resuscitation, making them "DNR" or "Do not resuscitate patients." Filling out such a standard form can be appropriate in some situations if the patient is truly terminal, but we always recommend that if possible, an attorney be consulted before ever filling one of these forms out.

Important information about advanced directives can be found at the Painlaw.org.

We recommend that you take a look at the the Protective Medical Decisions Document (PMDD) form which is distributed by the International Task Force on Euthanasia and Assisted Suicide. The PMDD is a protective Durable Power of Attorney for Health Care which is available from the International Task Force. It is a document in which you name someone you trust (a family member or a close friend) to make health care decisions for you if you are ever permanently or temporarily unable to make such decisions for yourself. It has many advantages over standard Advanced Directives and other forms routinely handed out at hospitals.

All material copyright of Hospice Patients Alliance ("HPA") unless otherwise credited.