Patient Self-Determination Act at admission

Question

A nurse is admitting an adult client to a hospital. The client has no advance directive and asks, "Do I have to have one to get treated here?" Which response by the nurse is correct?

1. A"No. Your care does not depend on having one, and I can give you written information on how to make one if you wish."✓ Correct

   Correct. Facilities must offer written information and may not make care depend on having an advance directive.

2. B"Yes. Federal law requires every admitted adult to complete an advance directive before treatment begins."✗ Incorrect

   Incorrect. The law requires facilities to offer information about advance directives, not to require them.

3. C"Yes, but only clients who are having surgery must complete one before treatment begins."✗ Incorrect

   Incorrect. No client can be required to complete an advance directive to receive care.

4. D"No, and the hospital is not allowed to ask clients whether they already have an advance directive."✗ Incorrect

   Incorrect. Facilities are required to ask and to document whether the client has an advance directive.

Answer

A. "No. Your care does not depend on having one, and I can give you written information on how to make one if you wish."

Rationale

Under the Patient Self-Determination Act, a hospital must, at admission, hand each adult a written explanation of their decision-making rights: they may agree to or turn down treatment, and they may prepare an advance directive if they choose. The admission record must show whether the client already has a directive, so staff ask and chart the answer. Having a directive is the client's choice, and the hospital cannot deny or limit care because the client has none.