It has come to my attention that the otherwise excellent article by Chambers et al,1 regarding the use of advance directives, contains an erroneous statement about the scope of the Patient Self-Determination Act. Specifically, the authors incorrectly stated that that statute "mandated that all Medicare patients be offered the opportunity to use or, if need be, develop autonomously derived advance medical directives."1(p545) This is, of course, incorrect. The Patient Self-Determination Act of 1990 (effective December 1,1991) requires that all hospitals and institutional providers, as well as health maintenance organizations, which participate in the Medicare and/or Medicaid Programs, give certain information about advance directives to all patients of those entities, not just patients receiving Medicare (or Medicaid) benefits.
A second point that I would like to make about this article is that the authors' findings may indicate that advance directives are inherently "pro-death" or "right-to-die" documents, not documents that