Advance Directives

In 1990, Congress passed the Patient Self-Determination Act, requiring providers to inform all adult patients about their rights to accept or refuse medical or surgical treatment and the right to execute an "advance directive" – a written instruction such as a living will or durable power of attorney for health care relating to the provision of health care when the individual is unable to make medical decisions. This documentation can be invaluable during end-of-life care, or when a patient is suddenly faced with a terminal diagnosis or is suddenly incapacitated due to a life-threatening injury or illness.

Tufts Health Plan recommends that the discussion and instruction on advanced directives for patients 18 years and older be included during the patient’s annual examination or during a routine follow-up visit. If this discussion has not occurred, we suggest that providers make it a priority for the next visit by making a note in the record and telling the patient that this topic will be discussed at the next visit.  

Both during and after the discussion, encourage the patient to discuss his or her wishes with family members and close friends, to send a copy to your office to be included in the patient’s medical record, and to give a copy to the person(s) designated to be involved in their care decisions should the need arise.

May 1, 2010