Abstract

On December 1, 1991, the Patient Self-Determination Act went into effect. The intent of the PSDA is to extend and support the patient's autonomy concerning medical treatment decisions into a period of decisional incapacity, by promoting the use of advance directives: living wills and/or a durable power-of-attorney for health care. ;Yet, despite broad social and legal support for advance directives and a growing public concern about controlling medical treatment at the end of life, only about 15% of the adult population has completed an advance directive. ;This research project surveys 267 patients with some form of cardiac disease or cardiac symptoms with scheduled appointments in an out-patient cardiology office setting. The participants completed an anonymous self-administered questionnaire which revealed that 27% had already completed an advance directive. Of the 73% who had not completed an advance directive, the reason most frequently cited for non-completion was that the patient's family would make the appropriate treatment decisions. To further understand this result, two subgroups of survey participants were developed. The first subgroup evaluated 149 participants chosen through the use of self-diagnosis and classification of current health status as indicators of the patient's knowledge, values and possibly denial as they related to the non-completion of advance directives. Within this subgroup, 36% indicated, once again, that their families would make health care decisions if they were unable to do so for themselves. The second subgroup consisted of 52 widows and widowers. Once again, family was a primary indicator for completion and non-completion of advance directives. Thus, a heavy reliance on families in end-of-life treatment decisions is suggested. Securing greater compliance of individuals with the Patient Self-Determination Act may require a greater reliance on family input. To do this, health care providers may have to explore the individual family structure and decision-making roles within a family rather than rely solely on patient autonomy as presupposed by the Patient Self-Determination Act