1	The History of Advance Directives Jean M. Deecki, RN, MPA Assistant Vice President, Patient Safety
2	"Pennsylvania Advance Directives" Pennsylvania Advance Directives For Healthcare Act – Act 24 of 1992 (Interim Final Rule) (Final Rule – 7/27/95)
3	Federal Patient Self-Determination Act of 12/1/91 Recognition of Rights of Patients to Make Choices Concerning Medical Care. Landmark Cases (Quinlan and Cryzan) Required by Medicare and Medicaid
4	Types of Advance Directives Living Will – Declaration if incapacitated and permanently unconscious or terminally ill. HCPA – Health Care Power of Attorney For all types of healthcare decisions (surgery, admission to hospital, etc.) Effective when patient is unable to make own decisions.
5	"Do I have to update" Do I have to update? No Is a notary required in Pennsylvania? No Can I cancel? Yes Do I have to have one? No
6	Must Haves Ask the patient if they have one – give to hospital/tell doctor. Hospital must provide written information. P/P written and provided to patient. Documentation in medical record. Compliance with state law. Education to patient and community.
7	Myths
8	Good Conscience – Non-Compliance Pennsylvania ` (a) Physician or Healthcare Provider - If an attending physician or healthcare provider cannot,in good conscience, comply with a declaration, or if the policies of the healthcare provider preclude compliance with a declaration, the attending physician or healthcare provider shall so inform the declarant. If the declarant is incompetent, they shall inform the declarant’s surrogate. If a surrogate is not named in the declaration, the provider shall make every reasonable effort to assist in the transfer of the declarant to another physician or healthcare provider who will comply with the declaration. Pa. stat. Ann.tit.20 (5409)
9	Good Conscience Non-Compliance Pennsylvania Liability – If transfer under subsection is not possible, the provision of life-sustaining treatment to a declarant shall not subject a healthcare provider to criminal or civil liability, or administrative sanction, for failure to carry out the provisions of a declaration.