Abstract
Advance directives (ADs) provide a way to express medical care preferences at the end of life, yet they are underutilized. This article analyzes the effect of the Patient Self-Determination Act and presents recommendations for the improvement of AD legislation. Although the Patient Self-Determination Act was intended to educate patients, clinicians, and the public about ADs, more work is needed to improve involvement in end-of-life care decision making for individuals who may be disenfranchised in this process.