In October 1990, The Annenberg Washington Program launched a new initiative--the Annenberg Critical Health Care Communications Project-- to examine the communication issues surrounding critical medical decisions, such as the termination of artificial life-support. This new project was inaugu rated when Program Director Newton N. Minow delivered the Rehabilitation Institute of Chicago's ninth annual James C. Hemphill Lecture. In his address, Communications in Medicine: Do Doctors and Lawyers Know How to Listen?, Minow noted:
Nowhere is communications more important, more lacking, or less studied than in the interaction between physicians and their patients, patients' families, medical colleagues, and other profession als about life and death decisions. Technology has given us the ability to extend life, both by moving forward the point at which a fetus may be viable and by prolonging life far beyond the time of independent viability. But the extraordinary achievements of technology pose fundamental questions which physicians, lawyers and judges cannot and should not answer alone. . . .On November 5, 1990, less than one month after the Rehabilitation Institute address, President Bush signed into law the Patient Self-Determination Act (PSDA). Introduced by Senators John C. Danforth and Daniel Patrick Moynihan, the Act requires hospitals and other health care providers receiving federal funds to give patients information explaining their legal options for refusing or accepting treatment should they become incapacitated. According to Senator Danforth, the law provides "people with information so that they can decide their own fate. . . . Let's let people have the dignity of deciding what they want and what they don't want."The time to discuss a person's desires regarding life-sustaining treatment is before the trauma occurs. Every person upon enter ing a hospital should be asked as part of the routine admissions process, "Have you made any provision for decision-making on your behalf if you are unconscious or incapacitated?" If the an swer is "yes," the document should be placed prominently in the patient's chart. If "no," an opportunity should be provided for discussing the various alternatives with a qualified professional.
In 1991, prior to the PSDA taking effect, the Program issued a White Paper by Annenberg Fellows Cate and Gill on The Patient Self-Determination Act: Implementation Issues and Opportunities. The White Paper detailed the Act's requirements, the legal options available for advance health care decision-making, current efforts by hospitals and professional groups to ensure compliance, and the unresolved issues posed by the Act. The report also included examples of living wills and powers of attorney from America's most respected medical and legal institutions.
The Program distributed more than 10,000 copies of the White Paper to hospitals, health care professionals, government officials, and the press. It rapidly became an indispensable resource for hospitals and other health care institu tions required to comply with the Act, especially since the government waited four months after the Act took effect before issuing regulations on its implementation.
In 1992, the Program and the American Association of Critical-Care Nurses (AACN) cosponsored a working group on Communications and the Patient Self-Determination Act: Strategies for Meeting the Educational Mandate. The working group included nurses, physicians, ethicists, communications experts, social workers, patients, lawyers, sociologists, and researchers. They met to address the principles of public information, communication, and educa tion as they apply to the PSDA; examine existing educational models developed to implement the PSDA; and define educational and communication strategies to facilitate nationwide implementation of the Act.
At the conclusion of the working group, which was moderated by Annenberg Fellow Gill, the participants issued a Consensus Statement stressing the impor tance of not only providing individuals with information about their rights under the PSDA, but also of facilitating a rapport between individuals and trusted professionals--for example, doctors, nurses, attorneys, or clergy-- about end-of-life decision-making. The Program later published a resource guide, Communications and the Patient Self-Determination Act: Strategies for Meeting the Educational Mandate, providing detailed information about the PSDA's educa tional requirements and the experience of health professionals, ethicists, and communications professionals in dealing with end-of-life issues. Related articles by Cate and Gill were published in the Medical Staff Counselor and in the Ameri can Bar Association's Health Lawyer.
The rights of individuals to make decisions regarding their own health care and the conditions under which they want medical treatment continued or discon tinued is now clearly recognized under both the Constitution and state law. More people are aware of their rights, and professionals--within the health care setting and without--are better equipped than ever to discuss options with individuals. Far-sighted projects, such as the comprehensive set of materials developed by the AACN, are helping to ensure that people in all segments of society, without regard for age, language, or literacy level, are meaningfully informed of their rights. The Program has helped to facilitate these projects and the timely implementation of the PSDA across the nation.