The effect of the Patient Self-Determination Act on health care delivery has been marginal at best. Alexis Foster used the term “lackluster” to describe to performance of this act. She argued that “there is reluctance on the part of many physicians to discuss end-of-life care with patients” and that this “significantly contributes to the failure of completion of advance directives by overlooking the importance of communication between the physician and the patient” (2011, p. 4). If physicians cannot endorse the act and communication and paperwork it takes to ensure compliance, then it is unlikely that the patients will take it seriously as well.

Additionally, according to Park, Eaton, & Palmer (1994), one of the concerns surrounding this act is the fact that the information has to be presented upon admission, which is not always an appropriate time for presentation. If a patient is acutely ill and presenting at a hospital or perhaps entering a nursing facility under duress, asking about what the patient wants to do in case of making serious decisions about their health or what they choose as an advance health care directive could be considered inappropriate, as these types of decisions are better made without the added stress of current illness or unwillingness for admission.

Medical records management procedures have had to respond to this piece of legislation by ensuring that all healthcare facility admissions have a record in the patient’s chart of the written notice of the right to make healthcare decisions, the right to accept or refuse medical treatment, and the right to have an advance health care directive. This has caused the expense of the generating of, training for, and inclusion of the paperwork in the patient’s chart (either paper or electronic) in addition to the cost of the time it takes to explain the document to the patient.

At a time when the act has been in place for nearly 25 years and the compliance has been “lackluster” at best, it is unlikely that the act now serves as nothing more than rote paperwork completed with little deep consideration, which is unfortunate, as these types of decisions are some of the most important decision a person can make regarding life, health, and death.