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I just started working in an outpatient surgical center. When a patient came in for a procedure and gave me her advance directive, my supervisor told me the facility doesn't honor advance directives. Is this legal? -S.B., OHIO


The Patient Self-Determination Act requires health care facilities participating in Medicare and Medicaid to ask all patients, upon admission, if they have a living will or special directive. Facility staff isn't required to help prepare these documents but can offer information if a patient is interested. Any living will or directive should be documented in the patient's medical record.


Anesthesia and surgery can create special circumstances that should be addressed by the facility's policies and procedures. For example, some normal practices related to anesthesia could be considered "resuscitation" in other circumstances. The American Society of Anesthesiologists (ASA) has established ethical guidelines for care of patients undergoing anesthesia who have do-not-resuscitate orders. The ASA recommends reviewing the patient's advance directive when possible, then making sure the patient or surrogate understands the procedures that are essential to her anesthesia care. Under the circumstances, she may decide to modify her directive, and the modifications should be documented.

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Handling advance directives improperly could put you, your colleagues, and the facility at great legal risk.