Overview
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ASSIGNMENT: Please respond to the two classmates discussion post below:
Megan Martinez:
The living will and the Patient Self-Determination Act are similar in that they both increase the participation of the patient in planning end of life decisions. The living will and PSDA both allow for the patient to make healthcare decisions in advance. A living will and PSDA differ in the fact that the PSDA is a federal law, and the living will is a legal document.
One problem that can arise with the implementation of a PSDA is communication. Additionally, "implementation may result in drowning patients in written materials on admission..." (Wolf et al., 1991). Even though someone may have made decisions about their end of life care they may not have properly communicated these wishes with their loved ones or physicians. This can lead to many complications when the time comes to actually utilize their plan/wishes.
My husband and I have recently spoken about putting together wills and are both interested in putting together an advance directive. For me I think they are important to have as a reference for my loved ones should I not be sound enough to make decisions on my own. While I can simply have a conversation with my loved ones about my wishes should anything happen to me, they may forget and will likely feel overwhelmed. Having an advanced directive should alleviate some anxiety and pressure from my loved ones as I have already provided my wishes. When thinking of developing an advanced directive I do feel a little overwhelmed since these decisions are so big and important. However, it gives me peace of mind that I am helping my family with such serious decisions. I do not want them to feel regret about decisions that could be made as I am the one that has given the guidance.
The process for creating a living will begins with thinking about your desires for end-of-life care. You can then find a document online or you can consult with legal counsel to put your wishes into a legal document. With the PSDA the healthcare providers are required to inform patients of their opportunities and rights regarding medical treatment. The process of advance directives requires you to think about what kind of treatments you would or would not like, selecting a healthcare proxy, and then completing legal documents with your wishes outlined.
Some challenges that arise when it comes to living wills, PSDA, and advance directives can be cultural in nature. Kastenbaum and Moreman (2024) discuss how some cultures have a reluctance to discuss death. This often leads to many people within the culture not even pursuing living wills, PSDA, or advance directives. Additionally, if they have a living will, PSDA, or advance directive in place they may still not communicate this with their family or physician's. In chapter 4 Kastenbaum and Moreman (2024) discuss alternate perspectives when it comes to the dying process such as," dying begins when the facts are recognized, dying begins when the facts are communicated, [and] dying begins when the patient realizes or accepts the facts." These different perspectives can also be a reason that challenges arise. People can be avoidant about talking about death because it can bring about such a finality to their lives that they are not ready for.
If a health professional violates an advances health directive there is potential for them to face legal repercussions given that an advance directive is a legally recognized document.
Have you ever had end of life conversations with your loved ones? If so, how did it go? If not, why?
References
Kastenbaum, R., & Moreman, C. M. (2024). Death, Society, and Human Experience (13th ed.). Routledge.
Wolf, S. M., Boyle, P., Callahan, D., Fins, J. F., Jennings, B., Lindemann Nelson, J., & Barondess, J. A. (1991). Sources of Concern about the Patient Self-Determination Act. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJM200303273481325
Rahlyn Green:
Advance directives, living wills, and the Patient Self-Determination Act (PSDA) all center on protecting patient autonomy and supporting individuals’ psychological need for control over their own healthcare decisions. From a psychological perspective, these tools are important because they reduce uncertainty and help people maintain a sense of identity and agency even when they may not be able to communicate. As discussed in Module 3, ethical principles like autonomy and informed consent are closely tied to how individuals perceive dignity, trust, and respect within medical systems. Both living wills and the PSDA encourage people to think ahead about treatment preferences, which can lower anxiety for patients and families by providing clear guidance during stressful situations (American Nurses Association, 2023).
Even though they share similar goals, a living will and the PSDA function differently. A living will is a personal legal document where someone outlines specific medical treatments they would or would not want if they became unable to speak for themselves. The PSDA, however, is a federal law that requires healthcare facilities receiving Medicare or Medicaid funding to inform patients of their rights to create advance directives. Psychologically, this difference matters because the living will involves personal reflection and meaning-making, while the PSDA focuses more on institutional responsibility and awareness. The law provides the structure, but the individual still has to engage in the decision-making process.
One major problem with the PSDA is that it often becomes a routine administrative task instead of a meaningful conversation. Patients may receive information about advance directives during hospital admissions when they are already overwhelmed or anxious. Research shows that stress and cognitive overload can reduce a person’s ability to process complex information, which may explain why many patients do not fully engage with advance care planning at that moment (National Institute on Aging, 2022). Module 3 highlighted how communication barriers and emotional states can influence ethical decision-making, which is especially relevant here.
When I think about whether I have made or would make an advance directive, I notice a mix of logical reasoning and emotional resistance. From a psychological standpoint, it makes sense to plan ahead because it reduces ambiguity and helps loved ones avoid difficult decision-making. At the same time, thinking about serious illness or death brings up discomfort and avoidance, which are common coping responses. Many young adults feel a sense of perceived invulnerability, which can make advance care planning feel unnecessary even when they understand its importance. Recognizing these internal reactions helps me see how psychological factors influence real-life healthcare decisions.
The processes for living wills, PSDA requirements, and advance directives also differ in meaningful ways. Creating a living will usually involves reflecting on personal values, completing legal forms, and discussing choices with trusted individuals. The PSDA process occurs at the institutional level, where healthcare organizations must provide education about patient rights and document whether advance directives exist. Advance directives overall may include a living will plus naming a healthcare proxy, which requires ongoing communication and emotional preparation. From a psychology perspective, these steps involve not just legal actions but also identity, values clarification, and coping with uncertainty.
There are many reasons people avoid talking about living wills or advance directives. Fear of death, cultural attitudes, denial, and anxiety about losing control can all act as psychological barriers. Some individuals may worry that discussing end-of-life planning will make the situation feel more real, which leads to avoidance behaviors. Module 3 emphasized the importance of empathy and understanding individual differences, since not everyone approaches these conversations with the same comfort level.
If a healthcare professional violates an advance directive, the consequences extend beyond legal issues — it can also damage trust and create psychological distress for families who feel the patient’s wishes were ignored. Respecting advance directives reinforces the therapeutic relationship and supports ethical care. Overall, living wills, the PSDA, and advance directives work together to promote autonomy, reduce uncertainty, and support psychological well-being during complex healthcare decisions.
Discussion Question: From a psychological perspective, do you think people avoid creating advance directives more because of emotional discomfort or because of lack of knowledge, and how could healthcare professionals address those barriers?
References:
American Nurses Association. (2023). Code of ethics for nurses with interpretive statements. American Nurses Publishing.
National Institute on Aging. (2022). Advance care planning: Healthcare directives. U.S. Department of Health & Human Services. https://www.nia.nih.gov