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Health & Balance

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Questions & Answers: Advance Directives and End of Life Decisions

Is there federal law about advance directives?

Yes, the Patient Self-Determination Act (PSDA) is a federal law regarding advance directives. It requires medical facilities that receive Medicaid and Medicare funds to have procedures for handling patients' advance directives, and to tell patients upon admission about their rights under state law to use advance directives. The PSDA does not set standards for what advance directives must say; it does not require facilities to provide advance directive forms; and it does not require people to have advance directives. Rather, the PSDA's purpose is to make people aware of their rights.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) evaluates and accredits nearly 19,000 healthcare organizations and programs in the United States. An independent, not-for-profit organization, JCAHO has developed standards for the documentation of patient wishes regarding advance directives, which apply to the vast majority of healthcare institutions.

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Will a pregnant woman's advance directives be honored?

Under some state laws, advance directive instructions to refuse treatment may not be honored while a woman is pregnant. If you wish your advance directives to apply during pregnancy, you will improve your chances of having this wish honored, although not ensure it, by stating the wish clearly.

Can I state my wishes about organ donation, cremation or burial in my advance directives?

Several states permit you to indicate your wishes regarding organ donation. In those states that do not specifically address the issue of organ donation you may state your wishes in your advance directive. However, you should consider expressing your wishes through a form designed for that purpose. You also should be sure to make your family aware of your wishes. Since your advance directive and the authority of your agent technically ceases upon your death, you should tell your wishes about cremation or burial to your family or the executor of your estate.

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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