Advance Directives

The Patient Self-Determination Act (PSDA)

The Patient Self-Determination Act (PSDA) is a federal law passed by Congress in 1990 which required certain health care providers to inform all adult patients about their rights to accept or refuse medical or surgical treatment and the right to execute an “advance directive.” The law became effective December 1, 1991.

Many people want to decide ahead of time what type of treatment they want to keep them alive. All of us who provide you with health care services are responsible for following your wishes. However, there may be times when you may not be able to decide or make your wishes known.

Table of Contents

Our Policy

Our Company will inform the patient or legal representative of the patient’s rights under the Patient Self Determination Act which are:

  1. Providers must provide written information to adult patients concerning:

    A. The patient’s rights under state law to make decisions regarding their medical care, including the right to accept/refuse medical treatment, the right to formulate advance directives and the right to use the toll free hotline number to lodge complaints concerning implementation of the advance directive requirements.
    B. The policies of the facility concerning the implementation of these rights.

  2. To document in the patient’s medical record whether or not the patient has executed an advance directive.
  3. Not to condition the provision of care or otherwise discriminate against the patient based on whether or not the patient has executed an advance directive.
  4. Ensure compliance with changes in the requirements of state law regarding advance directives within ninety (90) days from the effective date of the change.
  5. To provide education to the facility’s staff and the community on issues concerning advance directives.


  1. Attending Physician: The primary physician responsible for care and treatment of the patient.
  2. Decision Making Capacity: The ability to make choices which reflect an understanding and appreciation of the nature and consequences of one’s actions and the patient has not been declared incapacitated by any court nor has an appointed guardian over his/her person.
  3. Advance Directive: A generic term for instructions written in advance (i.e., living wills, durable power of attorney or some other form of advance directive) regarding one’s health care treatment choices. These instructions would be followed when an individual can no longer make decisions for themselves due to incompetency and/or incapacitation.
  4. Living Will: A written document voluntarily executed by the patient which allows life-sustaining procedures to be withdrawn or withheld. (May also be called a declaration depending on individual state law.)
  5. Durable Power of Attorney for Health Care: A written document voluntarily executed by the patient in which the patient names someone else to make health care decisions for them should they be unable to make them himself. (This person may also be called a Health Care Power of Attorney, Medical Power of Attorney, Healthcare Surrogate, Health Care Proxy or Agent, depending on individual state law.)
  6. Organ Donor/Anatomical Donation: Some states consider organ and tissue donation as a type of advance directive. Organs and tissues such as the eyes, heart, liver, kidneys, bone cartilage, bone marrow and skin may be used. This is a special way to help save someone else’s life through transplant surgery after you die. Organ and tissue donations are strictly voluntary and there are limiting factors. By signing a donor card or noting it on your advance directive or driver’s license, you can make your choice of organ or tissue donation known.
  7. Do Not Resuscitate (DNR) Orders: Another form of advance directive is called a DO NOT RESUSCITATE (DNR) Order. This order is signed by the person’s physician and identifies a person who does not want to be resuscitated from respiratory or cardiac arrest. Many states also have an out-of-hospital do not resuscitate (DNR) order (specific forms and some states have a special bracelet) that is used for example in the home setting to make sure the Emergency Medical Services/Technicians (EMS/EMT) do not resuscitate a person who does not want to be revived.

    You and your doctor may decide together that your doctor should write a DO-NOT-RESUSCITATE order. A DNR order is documented in your medical record and routinely reviewed; however, you may revoke your consent to such an order at any time. Unless the physician has written a specific order “DO NOT RESUSCITATE” or you have a valid “OUT-OF-HOSPITAL DO NOT RESUSCITATE” order, it is our policy that every patient will receive cardiopulmonary resuscitation (CPR). It is important to note that if you have an accident, such as choking on food, the DNR order still allows health care workers to give you the Heimlich maneuver or take other appropriate action.

    When a copy of the advance directive is provided to our company, we will respect and honor the written terms of the patient’s advance directive. Should a conflict arise between providers and the patient over ethical views, there is a procedure in place for dealing with patient grievances. If the conflict continues without resolution, the company will transfer the patient to another health care provider.

    If you executed an advance directive before July 1, 1991, you may want to review it, since a new law has gone into effect which gives you more options and information. Even if you decide to update it, the old documents are still legal.

Laws Related to Advance Directives

Laws related to advance directives vary from state to state: 


  • Office of the State Long Term Care Ombudsman
    PA Department of Aging
    555 Walnut Street, 5th Floor, Harrisburg, PA 17101
    Phone: (717) 783-1550 or (717) 783-7247
  • American Association of Retired Persons (AARP)
    30 N. 3rd Street, Suite 750, Harrisburg, PA 17101
    (866) 389-5654 toll free


  • Division of Service for Aging and Adults with Physical Disabilities
    1901 N Dupont Hwy, New Castle, DE 19720
    Phone: (800) 223-9074


New Jersey:

  • Department of Health and Senior Services
    P.0. Box 360, Trenton, NJ 08625-0360
    Phone: (609) 292-7837
    Toll-free in NJ: 1-800-367-6543



  • Maryland Department of Aging
    301, 1007, 2393, W Preston St, Baltimore, MD 21201
    Phone: (410) 767-1100