· Patient Self-Determination Act (1990) · Health Insurance Portability and Accountability Act of 1996 (HIPAA) · confidentiality and access to medical records · advance directives for health care · end-of-life; do not resuscitate (DNR) · Emergency Medical Treatment and Active Labor Act (EMTALA) (1986) · patient’s consent to care · culturally and linguistically appropriate services (CLAS) standards in health and health care Under a patchwork of laws, regulations, and ethical obligations, health service organizations have a responsibility to provide health services to patients. For example, the Joint Commission’s standards on patient rights and responsibilities address a provider’s obligation to keep patients informed and to effectively communicate with them. Patients have the right to participate in care decisions; the right to know care providers; and the right to informed consent. One federal law embraces these values: the Patient Self-Determination Act of 1990 (PSDA). The PSDA requires that health care organizations that receive Medicare and Medicaid funding provide information to patients about their right to accept or refuse life-sustaining treatments and their option to complete advance directives. Autonomy, or self-determination, is an underlying principle and obligation requiring that (1) patients participate in communications that allow for informational exchanges, with medical advice, and (2) patients are able to elect interventions. Patient-informed consent to care is a doctrine whereby the risks of the treatment, benefits of the treatment, and treatment alternatives must be disclosed to and acknowledged by the patient. This doctrine is based in case law, which is the legislative branch’s interpretation of codified laws. The body of rulings from key court cases produces useful information on legal expectation and the enforcement mechanisms in the law. Patients also determine their own end-of-life decisions based on their values and belief systems and not necessarily the provider’s code of ethics. As set forth in the PSDA, a patient’s wishes can be communicated through advanced directives, a durable power of attorney for health care, or a living will, as well as a do not resuscitate (DNR) order. These directives can be reduced to writing or can be an oral statement; both are legally binding in most jurisdictions. Providers are generally obligated to respect the patient’s wishes even when those wishes are counter to the provider’s personal values, the standard of care, and, at times, hospital procedure. It is critical that managers be aware of and provide operating guidance for health care organizations and providers about patient’s rights and preferences, especially at life’s end. Managers may be called in to mediate cultural, ethnic, and religious influences on patient and provider decision making. Health organizations and providers who recognize individuals’ cultural beliefs, values, attitudes, traditions, and language preferences c.