January 16, 1991

Providers to Advise of 'Medical Miranda'

JAMA. 1991;265(3):306. doi:10.1001/jama.1991.03460030008002

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HEALTH CARE provider organizations are being ordered to advise patients of their rights to refuse care and to name proxies in case they become incompetent.

The so-called medical Miranda warnings, explaining state law on living wills and durable powers of attorney for health care, will be the responsibility of all hospitals, nursing homes, health maintenance organizations (HMOs), hospices, and home health care agencies who want Medicare or Medicaid reimbursement as of November 1991.

Officially known as the Patient Self-Determination Act, the law was part of an omnibus budget bill passed last November. It requires that providers

  • Maintain written policies on refusal of care and advance directives

  • Give this written information to adults at the time of admission as hospital inpatients or as residents of a skilled nursing facility, before coming under the care of a home health agency or hospice, or upon enrollment in an HMO

  • Note in patient records