December of 1991, the Congress of the
United States passed the Patient Self-Determination Act (PSDA). Most,
but not all states, have passed similar legislation that, in many cases,
gives patients additional rights. The combined effect of federal
and state law is to require nearly all health care facilities to provide
adult patients with written information detailing their right to make
their own treatment decisions, including the right to refuse
life-sustaining treatment and to formulate an Advance Directive (state
law must be reviewed to confirm whether you are entitled to additional
rights beyond that provided by the PSDA).
There are two types of Advance Medical Directives:
- Instruction Directive that specifically outlines the care that you would allow
under certain circumstances (known generally as a “Living Will”);
- Proxy Directive that involves the appointment of a designated relative
or trusted friend to make medical decisions on your behalf (sometimes known
as a “Medical and/or Health Care Power of Attorney”).
You may choose either one or a combination of the two, sometimes known as a
Making life and death decisions requires adequate knowledge being shared
by the primary care doctor as to all possible options and associated risks.
A well-designed Treatment Directive, therefore, also involves
The right to be informed about all treatment options is currently being challenged in the
New Jersey court system. Some doctors may decide to withhold information from a
patient because they feel it is in the patient’s best interest not to
know. The doctor may feel such honest exchange will only serve to cause his or her patient
unnecessary anxiety. Others may be restricted from sharing treatment options
with a patient due to gag rules imposed by managed care providers.
If you want to be informed about your medical care, you or the person you
designate to make decisions for you, must be assertive when seeking this
information. Ask your doctor to be honest with you. Ask that he/she inform you of
all your options. Ask for the best resources so that you may investigate options
on your own. Be sure that the friend or relative you choose to make your
decisions will also be assertive. Being proactive and asking the right questions
can help you make more informed decisions about medical care.
This page was contributed by Robert J. Romano, Jr., an Elder Law Attorney located in
Paramus, New Jersey.