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Report No. 196

Some Legislations in US

(1) The Patient Self Determination Act, 1990: (42 USC 1395 cc(a))

Soon after Cruzan, the Federal Legislature of US passed the Patient Self Determination Act, 1990 which came into force w.e.f. 1 st December, 1991. It applies to hospitals, nursing facilities, hospices, and health-care providers receiving funds under the Plan. It requires that these institutions give patients information concerning their legal rights to make decisions about the medical care and treatment they are about to receive. (This Act was part of the Omnibus Budget Reconciliation Act, 1990).

Under section 1902(2)(w)(1) of the Act (see section 1902), the above institutions have:

(1) (A) to provide to each adult individual receiving medical care by or through the provider or organization, written information, concernin.-

(i) an individual's rights under State Law (whether statutory or as recognized by the Courts of the State) to make decisions concerning such medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives) (as defined in paragraph (3), and

(ii) the provider's or organization's written policies respecting the implementation of such rights;

(B) to document in the individual's medical record whether or not the individual has executed an advance directive;

(C) not to condition the provisions of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive;

(D) to ensure compliance with requirements of State law (whether statutory or as recognized by the Courts of the State) respecting advance directives; and

(E) to provide (individually or with others) for education for staff and the community on issues concerning advance directives.

Subpara (C) (above) shall not be considered as requiring the provisions of care which conflicts with an advance directive.

(2) The written information described in para 1(A) shall be provided to an adult individua.-

(A) in the case of a hospital, at the time of the individual's admission as in patient,

(B) in the case of a nursing facility, at the time of ....

(C) in the case of a provider of home health, at the time of ....

(D) in the case of a hospice program, at the time of ....

(E) in the case of a health monitor program, at the time of....

(3) Nothing in this section shall be constituted to prohibit the application of a State law which allows for an objection on the basis of conscience for any health care provider or any agent of such provider which, as a matter of conscience, cannot implement an advance directive.

(4) In this subsection, the term 'advance directive' means a written instruction, such as a living will or durable power of attorney for health care, recognized under State Law (whether statutory or as recognised by the Courts of the State) and relating to the provisions of such care when the individual is incapacitated.

The Act also provides for 'information respecting advance directives, effective data, public education campaign etc.'

Thereafter, certain Regulations called, 'The Federal Patient SelfRegulation Act, Final Regulations' have been passed.



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