Case Study
The Patient Self-Determination Act (PSDA) was passed as part of the Omnibus Budget Reconciliation Act of 1990. The law requires all health-care facilities receiving reimbursement from Medicare and Medicaid to ask individuals, on admission, if they have an advance directive. The law requires that individuals be given written information explaining advance directive documents if they so choose and the opportunity to create an advanced directive.
Since 1990, research regarding the role ethnicity plays in end-of-life decisions has been conducted. This research shows that regardless of the specific ethnicity, members of minority groups are generally less desirous of completing advance directives than are whites. The research suggests that end-of-life choices are more related to race, ethnicity, and culture than to age, education, or socioeconomic status. Barriers made by the law that surfaced during the research are that (1) the PSDA is based on written communication and as
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