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The Patient Self-Determination Act (PSDA) was passed by the United States Congress in 1990 as an amendment to the Omnibus Budget Reconciliation Act of 1990. Effective on December 1, 1991, this legislation required many hospitals, nursing homes, home health agencies, hospice providers, health maintenance organizations (HMOs), and other health care institutions to provide information about advance health care directives to adult patients upon their admission to the healthcare facility.〔(Health Care Advance Directives - What is the Patient Self-Determination Act? ). ''American Bar Association''.〕〔(What is the Patient Self-Determination Act? ). ''Legal HelpMate''.〕 This law does not apply to individual physicians. Because the 1991 PSDA does not apply to individual physicians, private clinics and practices, most of whom are incorporated for-profit organizations, the problem of cruel over treatment for profit of the elderly on Medicare/Medicaid was not controlled to the extent that the Congress hoped would be possible when the states would implement the goals of the 1991 PSDA in state laws. (Recently, in 2012, the newspapers have revealed that The United States Department of Health and Human Services and the Department of Justice have cooperated to prosecute over treatment of patients under the federal false claims act.) The goals of the 1991 PSDA are covered in the PURPOSE section, below. Section 1233 of the proposed America's Affordable Health Choices Act of 2009 (H.R. 3200) would have authorized reimbursements for physician counseling regarding advance directives (once every five years)〔(Advance Care Planning in Health Care Reform Legislation ). ''National Hospice and Paliative Care Organization''.〕 but it was not included in the Patient Protection and Affordable Care Act of 2010 because of controversy over what were characterized as "death panels." Unfortunately, because the law of the 1991 PSDA does not require or mandate the treating physicians—after an educated "terminal" prognosis that is shared with the patient—to seek informed consent from elderly and terminal Medicare/Medicaid patients for either Curative Care under Medicare or palliative care, transition to Hospice in the last six months of life (also paid or out of the Medicare purse), the goals of the PSDA are not realized. Patient self rationing of expensive medical care at the end of life through the process of the advance directive under the provisions of the 1991 PSDA is discouraged because the patients have not had end-of-life conversations with the treating physicians. ==Requirements== The requirements of the PSDA are as follows: : *Patients are given written notice upon admission to the health care facility of their decision-making rights, and policies regarding advance health care directives in their state and in the institution to which they have been admitted. Patient rights include: ::#The right to facilitate their own health care decisions ::#The right to accept or refuse medical treatment ::#The right to make an advance health care directive : *Facilities must inquire as to whether the patient already has an advance health care directive, and make note of this in their medical records. : *Facilities must provide education to their staff and affiliates about advance health care directives. : *Health care providers are not allowed to discriminately admit or treat patients based on whether or not they have an advance health care directive. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Patient Self-Determination Act」の詳細全文を読む スポンサード リンク
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