Health Hippo: Advance Directives

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Pay your own way. On April 30, 1997, President Clinton signed into law a bill that prevents federal government health care programs from reimbursing the costs associated with physician-assisted suicide. The Assisted Suicide Funding Restriction Act of 1997, codified at 42 USC 14401.

The new law also included funding for a Suicide Prevention program designed to to reduce the rate of suicide (including assisted suicide) among persons with disabilities or terminal or chronic illness by furthering knowledge and practice of pain management, depression identification and treatment, and issues related to palliative care and suicide prevention.. See Suicide Prevention: Efforts to Increase Research and Education in Palliative Care. HEHS-98-128. April 30, 1998. (Report on the extent to which projects under section 781 of the Public Health Service Act have furthered the knowledge and practice of palliative care, particularly with regard to curricula offered and used in medical schools).

In part due to the landmark Supreme Court decision in Cruzan v. Director, Mo. Dept. of Health, consumers have become increasingly interested in predetermining decisions about their health care. The Patient Self-Determination Act requires hospitals, skilled nursing facilities, home health agencies, hospice programs and HMOs to maintain written policies and procedures guaranteeing that every adult receiving medical care be given written information concerning living wills, durable powers of attorney for health care or "Advance directives".

The Pacific Northwest has received much attention for state laws relating to physician-assisted suicide for terminally ill patients. One of these laws was recently upheld by the 9th Circuit court of Appeals in Compassion in Dying v. State of Washington.

The recent 2d Circuit decision in Quill v. Vacco struck down a law prohibiting physician assisted suicide. On appeal, the U.S. Supreme Court left it to the states to determine whether to prohibit physician-assisted suicide, finding no constitutional protection for terminally ill patients seeking a physician's assistance in ending their lives.

For an assessment of the effectiveness of the Patient Self-Determination Act in promoting patient involvement in health care decision making, see Patient Self-Determination Act: Providers Offer Information on Advance Directives but Effectiveness Uncertain (Letter Report, 09/01/95,GAO/HEHS-95-135).

U.S. Code

THE PATIENT SELF-DETERMINATION ACT

Cases

Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261 (1990) (U.S. Constitution does not forbid Missouri to require that evidence of an incompetent's wishes as to the withdrawal of life-sustaining treatment be proved by clear and convincing evidence).
Compassion in Dying v. State of Washington (9th Cir. March 9, 1996)(striking down decision barring physician assisted suicide)
Quill v. Vacco (2d Cir. April 2, 1996) (NY statute prohibiting physician-assisted suicide violates Equal Protection Clause). Decision of the U.S. Supreme Court.
Krischer v. McIver, No. 89,837 (Fl. Sup. Ct. July 17, 1997) Physician-assisted suicide directly contradicts ethical standards and compromises the integrity of the medical profession and the role of hospitals in caring for patients.

Reports, Bills &Testimony

HCFA: Advance Directives You can decide in Advance what medical treatment you want to receive in the event you become physically or mentally unable to communicate your wishes.
Suicide Prevention: Efforts to Increase Research and Education in Palliative Care. HEHS-98-128. April 30, 1998. Report on the extent to which projects under section 781 of the Public Health Service Act have furthered the knowledge and practice of palliative care, particularly with regard to curricula offered and used in medical schools.
Patient Self-Determination Act: Providers Offer Information on Advance Directives but Effectiveness Uncertain (Letter Report, 09/01/95,GAO/HEHS-95-135). GAO provided information on the implementation of the Patient Self-Determination Act (PSDA), and the effectiveness of Advance directives in ensuring a patient's desired care.
Complying with the Funeral Rule These guidelines are intended to help you, the funeral provider, comply with the Federal Trade Commission (FTC or Commission) Funeral Rule. The Funeral Rule went into effect on April 30, 1984. The Commission has revised the Rule, and these revisions will become effective July 19, 1994.
Funerals: A Consumer Guide (Federal Trade Commission) Each year, Americans arrange more than 2 million funerals for family and friends. Because funerals can cost thousands of dollars, you should be aware of federal regulations that can help protect you from overpaying.
Physician Assisted Suicide as a Constitutional Issue By Professor Thomas C. Marks, Jr. It is the author's opinion that physician assisted suicide should enjoy little or no constitutional protection. The legislature is in a much better position to say what should and should not be allowed in this most delicate area. At the very most, constitutional intervention should merely require that legislative prevention or regulation of physician assisted suicide be rational.
Physician-assisted suicide and managed care Steven H. Miles, MD. I do not believe that Minnesota's managed care plans will or should support state legislation to legalize PAS. The conflict of interest between the cost savings that could derive from PAS and insurance coverage of chronically and terminally ill patients is sufficiently grave to disqualify managed care plans from having an appropriate role in the debate.
UCI Willed Body Program Under Investigation A universal program in which people can donate their body for medical science after death.
University of Washington Medical School Willed Body Program What it is and what it's not.
Assisted Suicide Bills (106th Congress)
106th Congressional Record: "Assisted Suicide"
Search "Assisted Suicide"