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Subdural hematoma
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Subdural hematoma
Synonyms
Subdural haematoma, subdural haemorrhage
Subdural hematoma as marked by the arrow with significant midline shift
Specialty
Neurosurgery
A subdural hematoma (SDH), is a type of hematoma, usually associated with traumatic brain injury. Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. Subdural hematomas are often life-threatening when acute. Chronic subdural hematomas, however, have a better prognosis if properly managed.
In contrast, epidural hematomas are usually caused by tears in arteries, resulting in a build-up of blood between the dura mater and skull. Subarachnoid hemorrhage, the third type of brain hemorrhages, is bleeding into the subarachnoid space — the area between the arachnoid membrane and the pia mater surrounding the brain.
Contents
[hide]
1 Classification
2 Signs and symptoms
3 Causes
3.1 Risk factors
4 Pathophysiology
5 Diagnosis
6 Treatment
7 See also
8 References
9 External links
Classification[edit]
Subdural hematomas are divided into acute, subacute, and chronic, depending on the speed of their onset.[1] Acute subdural hematomas that are due to trauma are the most lethal of all head injuries and have a high mortality rate if they are not rapidly treated with surgical decompression.[2]
Acute bleeds often develop after high speed acceleration or deceleration injuries and are increasingly severe with larger hematomas. They are most severe if associated with cerebral contusions.[3] Though much faster than chronic subdural bleeds, acute subdural bleeding is usually venous and therefore slower than the typically arterial bleeding of an epidural hemorrhage. Acute subdural bleeds have a high mortality rate, higher even than epidural hematomas and diffuse brain injuries, because the force (acceleration/deceleration) required to cause them causes other severe injuries as well.[4] The mortality rate associated with acute subdural hematoma is around 60 to 80%.[5]
Chronic subdural bleeds develop over a period of days to weeks, often after minor head trauma, though such a cause is not identifiable in 50% of patients.[6] They may not be discovered until they present clinically months or years after a head injury.[7] The bleeding from a chronic bleed is slow, probably from repeated minor bleeds, and usually stops by itself.[8][9] Since these bleeds progress slowly, they present the chance of being stopped before they cause significant damage. Small chronic subdural hematomas, those less than a centimeter wide, have much better outcomes than acute subdural bleeds: in one study, only 22% of patients with chronic subdural bleeds had outcomes worse than "good" or "complete recovery".[3] Chronic subdural hematomas are common in the elderly.[7]
Signs and symptoms[edit]
Hematoma type
Epidural
Subdural
v
t
e
Location
Between the skull and the outer endosteal layer of the dura mater Between dura mater and arachnoid mater.[10]
Involved vessel
Temperoparietal locus (most likely) - Middle meningeal artery
Frontal locus - anterior ethmoidal artery
Occipital locus - transverse or sigmoid sinuses
Vertex locus - superior sagittal sinus Bridging veins
Symptoms (depend on severity)[11]
Lucid interval followed by unconsciousness Gradually increasing headache and confusion
CT appearance
Biconvex lens Crescent-shaped
Symptoms of subdural hemorrhage have a slower onset than those of epidural hemorrhages because the lower pressure veins bleed more slowly than arteries. Therefore, signs and symptoms may show up in minutes, if not immediately[12] but can be delayed as much as 2 weeks.[13] If the bleeds are large enough to put pressure on the brain, signs of increased ICP (intracranial pressure) or damage to part of the brain will be present.[3]
Other signs and symptoms of subdural hematoma can include any combination of the following:
A history of recent head injury
Loss of consciousness or fluctuating levels of consciousness
Irritability
Seizures
Pain
Numbness
Headache (either constant or fluctuating)
Dizziness
Disorientation
Amnesia
Weakness or lethargy
Nausea or vomiting
Loss of appetite
Personality changes
Inability to speak or slurred speech
Ataxia, or difficulty walking
Loss of muscle control
Altered breathing patterns
Hearing loss or hearing ringing (tinnitus)
Blurred Vision
Deviated gaze, or abnormal movement of the eyes.[3]
Causes[edit]
Subdural hematomas are most often caused by head injury, when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages, subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces.[3][8] Subdural hemorrhage may be seen in shaken baby syndrome, in which similar shearing forces may cause retinal hemorrhages. Subdural hematoma is also commonly seen in the elderly and in alcoholics, who have evidence of cerebral atrophy. Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. It is also more common in patients on anticoagulants or antiplatelet drugs, such as warfarin and aspirin. Patients on these medications can have a subdural hematoma after a relatively minor traumatic event. A further cause can be a reduction in cerebral spinal fluid pressure which can create a low pressure in the subarachnoid space, pulling the arachnoid away from the dura mater and leading to a rupture of the blood vessels.
Risk factors[edit]
Factors increasing the risk of a subdural hematoma include very young or very old age. As the brain shrinks with age, the subdural space enlarges and the veins that traverse the space must travel over a wider distance, making them more vulnerable to tears. This and the fact that the elderly have more brittle veins make chronic subdural bleeds more common in older patients.[6] Infants, too, have larger subdural spaces and are more predisposed to subdural bleeds than are young adults.[3] For this reason, subdural hematoma is a common finding in shaken baby syndrome. In juveniles, an arachnoid cyst is a risk factor for a subdural hematoma.[14]
Other risk factors for subdural bleeds include taking blood thinners (anticoagulants), long-term alcohol abuse, dementia, and the presence of a cerebrospinal fluid leak.[15]
Pathophysiology[edit]
Micrograph of a chronic subdural hematoma, as demonstrated by thin strands of collagen and neovascularization. HPS stain.
Acute subdural haematoma is usually caused external trauma that creates tension in the wall of a bridging vein as it passes between the arachnoid and dural layers, i.e. the subdural space, of the brain's lining. This is because in the short course of the vein in the subdural space, circumferential arrangement of collagen surrounding the vein causes it to be susceptible to tear by this tension. However, intracerebral hemorrhage and rupture of cortical vessels (vessels running on the surface of the brain) can also cause subdural haematoma. Such haematoma usually accumulates in between the two layers of the dura membrane. Such haematoma can cause ischemic brain damage by two mechanisms: pressure effect on the cortical blood vessels,[16] and vasoconstriction due to the substances may be released from the collected material in a subdural hematoma, causing further ischemia under the site by restricting blood flow to the brain.[9] When the brain is denied adequate blood flow, a biochemical cascade known as the ischemic cascade is unleashed, and may ultimately lead to brain cell death.[17] This condition lead to higher risk of death for the patient.[16]
Subdural haematoma may continually grow in size by the pressure effect of the haematoma on the brain. This causes the intracranial pressure of the brain to rise, squeezing the intracranial blood into the dural venous sinuses, raising the dural venous pressure, and resulting in more bleeding from the ruptured bridging veins. Subdural haematoma only stopped to enlarge when the pressure of the haematoma equalises with the intracranial pressure of the brain, as the space for haematoma expansion getting smaller and smaller.[16]
Chronic subdural haematoma is usually asymptomatic until four to seven weeks later. In this case, accumulation of blood in the dural space is caused by inflammation. Trauma causes damage to the dural border cells (e.g. separation of dura membrane bilayer), resulting in inflammatory reaction.[18] Post craniotomy for unruptured intracranial aneurysm is another risk factor for the development of chronic subdural haematoma. The incision of arachnoid membrane during the operation causes leakage of CSF into the subdural space, leading to inflammation. This post-operative complication would usually resolved spontaneously.[19] Inflammation causes the new membrane formation through fibrosis. The inflammatory process also produces new fragile and leaky blood vessels through angiogenesis, permitting the leakage of red blood cells, white blood cells, and plasma into the haematoma cavity and easily causes mirco bleeds. Besides, tearing of arachnoid mater during trauma causes leakage of cerebrospinal fluid (CSF) into the haematoma cavity, causing increase in haematoma size over time. Excessive fibrinolysis is another factor that causes continuous bleeding. Examples of pro-inflammatory mediators acted in the haematoma expansion process are: Interleukin 1α (IL1A), Interleukin 6, Interleukin 8; while the anti-inflammatory mediator is Interleukin 10. Mediators that promote angiogenesis are: angiopoietin and vascular endothelial growth factor (VEGF). Meanwhile, prostaglandin E2 promotes the expression of VEGF. Matrix metalloproteinases remove surrounding collagen, thus providing space for new blood vessels to grow.[18]
Diagnosis[edit]
A subdural hematoma demonstrated by CT.
It is important that a person receive medical assessment, including a complete neurological examination, after any head trauma. A CT scan or MRI scan will usually detect significant subdural hematomas.
Subdural hematomas occur most often around the tops and sides of the frontal and parietal lobes.[3][8] They also occur in the posterior cranial fossa, and near the falx cerebri and tentorium cerebelli.[3] Unlike epidural hematomas, which cannot expand past the sutures of the skull, subdural hematomas can expand along the inside of the skull, creating a concave shape that follows the curve of the brain, stopping only at the dural reflections like the tentorium cerebelli and falx cerebri.
On a CT scan, subdural hematomas are classically crescent-shaped, with a concave surface away from the skull. However, they can have a convex appearance, especially in the early stage of bleeding. This may cause difficulty in distinguishing between subdural and epidural hemorrhages. A more reliable indicator of subdural hemorrhage is its involvement of a larger portion of the cerebral hemisphere since it can cross suture lines, unlike an epidural hemorrhage. Subdural blood can also be seen as a layering density along the tentorium cerebelli. This can be a chronic, stable process, since the feeding system is low-pressure. In such cases, subtle signs of bleeding such as effacement of sulci or medial displacement of the junction between gray matter and white matter may be apparent.
Fresh subdural bleeding is hyperdense, but becomes more hypodense over time due to dissolution of cellular elements. After somewhere between 3–14 days, the bleeding becomes isodense with brain tissue and may therefore be missed.[20] Subsequently, it will become more hypodense than brain tissue.
Treatment[edit]
Treatment of a subdural hematoma depends on its size and rate of growth. Some small subdural hematomas can be managed by careful monitoring until the body heals itself. Other small subdural hematomas can be managed by inserting a temporary small catheter through a hole drilled through the skull and sucking out the hematoma; this procedure can be done at the bedside. Large or symptomatic hematomas require a craniotomy, the surgical opening of the skull. A surgeon then opens the dura, removes the blood clot with suction or irrigation, and identifies and controls sites of bleeding.[21][22] Postoperative complications include increased intracranial pressure, brain edema, new or recurrent bleeding, infection, and seizure. The injured vessels must be repaired.
Depending on the size and deterioration, age of the patient, and anaesthetic risk posed, subdural hematomas occasionally require craniotomy for evacuation; most frequently, simple burr holes for drainage; often conservative treatment; and rarely, palliative treatment in patients of extreme age or with no chance of recovery.[23]
In those with a chronic subdural hematoma, but without a history of seizures, the evidence is unclear if using anticonvulsants is harmful or beneficial.[24]
See also[edit]
Concussion
Diffuse axonal injury
Epidural hematoma
Extra-axial hemorrhage
Intra-axial hemorrhage
Head injury
Subarachnoid hemorrhage
Traumatic brain injury
References[edit]
Jump up ^ Subdural Hematoma Surgery at eMedicine
Jump up ^ "Acute Subdural Hematomas". UCLA Health. Retrieved 21 July 2011.
^ Jump up to: a b c d e f g h Imaging in Subdural Hematoma at eMedicine
Jump up ^ Penetrating Head Trauma at eMedicine
Jump up ^ Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology at eMedicine
^ Jump up to: a b Downie A. 2001. "Tutorial: CT in head trauma". Retrieved on August 7, 2007.
^ Jump up to: a b Kushner D (1998). "Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment". Archives of Internal Medicine. 158 (15): 1617–1624. doi:10.1001/archinte.158.15.1617. PMID 9701095.
^ Jump up to: a b c University of Vermont College of Medicine. "Neuropathology: Trauma to the CNS." Accessed through web archive on August 8, 2007.
^ Jump up to: a b Graham DI and Gennareli TA. Chapter 5, "Pathology of brain damage after head injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.
Jump up ^ "Subdural Haematoma". Patient. Patient Platform Ltd. Retrieved 30 January 2017.
Jump up ^ Gillet, Jane. "What's the Difference Between a Subdural and Epidural Hematoma?" (PDF). brainline.org. Retrieved 30 January 2017.
Jump up ^ "Subdural hematoma : MedlinePlus Medical Encyclopedia". Nlm.nih.gov. 2012-06-28. Retrieved 2012-07-27.
Jump up ^ Sanders MJ and McKenna K. 2001. Mosby’s Paramedic Textbook, 2nd revised Ed. Chapter 22, "Head and facial trauma." Mosby.
Jump up ^ Mori K, Yamamoto T, Horinaka N, Maeda M (2002). "Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst". J. Neurotrauma. 19 (9): 1017–27. doi:10.1089/089771502760341938. PMID 12482115.
Jump up ^ Beck J; Gralla J; Fung C; Ulrich C; Schuct P; Fichtner J; ... Raabe A (December 2014). "Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients". Journal of Neurosurgery. 121 (6): 1380–1387. doi:10.3171/2014.6.JNS14550. PMID 25036203. Retrieved 3 April 2016.
^ Jump up to: a b c Miller, Jimmy D; Nader, Remi (June 2014). "Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth". Journal of Neurosurgery. 120 (6): 1378–1384. doi:10.3171/2013.10.JNS13272.
Jump up ^ Tandon, PN (2001). "Acute subdural haematoma : a reappraisal". Neurology India. 49 (1): 3–10. Retrieved 26 November 2017. . The possibility of direct effect of some vasoactive substances released by the blood clot, being responsible for the ischaemia, seems attractive.
^ Jump up to: a b Edlmann, Ellie; Giorgi-Coll, Susan; Whitfield, Peter C. (30 May 2017). "Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy". Journal if Neuroinflammation. 14: 108. doi:10.1186/s12974-017-0881-y. PMC 5450087  . PMID 28558815.
Jump up ^ Tanaka, Y; Ohno, K (1 June 2013). "Chronic subdural hematoma - an up-to-date concept" (PDF). Journal of Medical and Dental Sciences. 60 (2): 55–61. PMID 23918031. Retrieved 26 November 2017.
Jump up ^ "Intracranial Hemorrhage - Subdural Hematomas (SDH)". Loyola University Chicago. Retrieved 2018-01-06.
Jump up ^ Koivisto T, Jääskeläinen JE (2009). "Chronic subdural haematoma—to drain or not to drain?". Lancet. 374 (9695): 1040–1041. doi:10.1016/S0140-6736(09)61682-2.
Jump up ^ Santarius T, Kirkpatrick PJ, Dharmendra G, et al. (2009). "Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial". Lancet. 374 (9695): 1067–1073. doi:10.1016/S0140-6736(09)61115-6.
Jump up ^ de Araújo Silva, DaniloOtávio; Matis, GeorgiosK; Kitamura, MatheusAugusto Pinto; de Carvalho Junior, EduardoVieira; Silva, Monalisade Moura; Pereira, CarlosUmberto; da Silva, JoacilCarlos; de Azevedo Filho, HildoRocha Cirne; Costa, LeonardoFerraz; Barbosa, Breno JoséA. P.; Birbilis, TheodossiosA (2012). "Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!". Surgical Neurology International. 3 (1): 150. doi:10.4103/2152-7806.104744. ISSN 2152-7806.
Jump up ^ Ratilal, BO; Pappamikail, L; Costa, J; Sampaio, C (Jun 6, 2013). "Anticonvulsants for preventing seizures in patients with chronic subdural haematoma". The Cochrane Database of Systematic Reviews. 6: CD004893. doi:10.1002/14651858.CD004893.pub3. PMID 23744552.
External links[edit]
Classification
V · T · D
ICD-10: I62.0, P10.0, S06.5
ICD-9-CM: 852.2 - traumatic; 432.1 - nontraumatic
MeSH: D006408
DiseasesDB: 12614
External resources
MedlinePlus: 000713
eMedicine: neuro/575
Wikimedia Commons has media related to Subdural hematoma.
Subdural Hematoma at eMedicine
Imaging and Mechanism of Subdural Hematoma - MedPix
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Baba (name)
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For other uses, see Baba (disambiguation).
Baba is a name and may refer to:
Contents
[hide]
1 Given name
2 Surname
3 Honorific
4 Familial
5 See also
Given name[edit]
Baba Ishak, Seljuk Turk
Baba Novac, a Serbian hajduk and a national hero in Serbia and Romania
Baba Nobuharu (1514/15–1575), Japanese samurai
Ahmad Baba al Massufi (1556–1627), Malian politician
Baba Juice, nickname of B. J. Johnson (born 1987), American swimmer
Surname[edit]
Aglar Baba, Turkish religious leader
Corneliu Baba (1906–1997), Romanian painter
Frank Shozo Baba (1915–2008), Japanese American worked for Voice of America and Japan
Ghafar Baba (1925–2006), Malaysian politician
Gül Baba (died 1541), Ottoman Bektashi dervish poet
James Baba, Ugandan politician
Jaroslav Bába (born 1984), Czech high jumper
Kikutaro Baba (1905–2001), Japanese malacologist
Masao Baba (1892–1947), Japanese general
Otman Baba, Sufi saint
Shohei Baba (1938–1999), Japanese wrestler
Tupeni Baba, Fijian politician
Honorific[edit]
Baba is often used as an honorific or sobriquet, usually prefixed or suffixed to a name.
Familial[edit]
Baba, Grandmother (Slavic Languages)
Baba, Dad/Daddy (Greek language)
Baba, Grandad or elderly person(Punjabi language)
Baba, Father/dad(Marathi, Hindi(In Hindi it is mainly called papa which also means the same))
See also[edit]
Baba (honorific)
Retrieved from "https://en.wikipedia.org/w/index.php?title=Baba_(name)&oldid=811693973"
Categories:
Turkish-language surnames
Turkish masculine given names
Arabic-language surnames
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text:
State of the Union
From Wikipedia, the free encyclopedia
This is the latest accepted revision, reviewed on 13 April 2018.
Jump to: navigation, search
"States of the Union" redirects here. For other uses, see State of the Union (disambiguation).
For the most recent State of the Union address, see 2018 State of the Union Address.
The State of the Union Address is an annual message[1] presented by the President of the United States to a joint session of the United States Congress, except in the first year of a new president's term.[2] The message includes a budget message and an economic report of the nation, and also allows the President to outline their legislative agenda (for which the cooperation of Congress is needed) and national priorities.[3]
The address fulfills rules in Article II, Section 3 of the U.S. Constitution, requiring the President to periodically "give to the Congress Information of the State of the Union, and recommend to their Consideration such measures as he shall judge necessary and expedient."[1] During most of the country's first century, the President primarily only submitted a written report to Congress. After 1913, Woodrow Wilson, the 28th U.S. President, began the regular practice of delivering the address to Congress in person as a way to rally support for his agenda.[1] With the advent of radio and television, the address is now broadcast live across the country on many networks.[4]
Contents
[hide]
1 Ceremony
2 History
3 Delivery of the speech
3.1 Invitations
3.2 Protocol of entry into House chamber
3.3 Designated survivor and other logistics
4 Opposition response
5 Significance
6 Local versions
7 Historic speeches
8 TV ratings
9 See also
10 References
11 External links
Ceremony[edit]
The practice arises from a duty given to the president in the Constitution of the United States:
He shall from time to time give to Congress information of the State of the Union and recommend to their Consideration such measures as he shall judge necessary and expedient.
—  Article II, Section 3 of the U.S. Constitution
Although the language of this State of the Union Clause[5] of the Constitution is not specific, since the 1930s, the President makes this report annually in late January or early February. Between 1934 and 2013 the date has been as early as January 3,[6] and as late as February 12.[7]
While not required to deliver a speech, every president since Woodrow Wilson, with the notable exception of Herbert Hoover,[8] has made at least one State of the Union report as a speech delivered before a joint session of Congress. Before that time, most presidents delivered the State of the Union as a written report.[6]
Since Franklin Roosevelt, the State of the Union is given typically each January before a joint session of the United States Congress and is held in the House of Representatives chamber of the United States Capitol. Newly inaugurated presidents generally deliver an address to Congress in February of the first year of their term, but this speech is not officially considered to be a "State of the Union".[6]
What began as a communication between president and Congress has become a communication between the president and the people of the United States. Since the advent of radio, and then television, the speech has been broadcast live on most networks, preempting scheduled programming. To reach the largest audience, the speech, once given during the day, is now typically given in the evening, after 9pm ET (UTC-5).
History[edit]
George Washington's handwritten notes for the first State of the Union Address, January 8, 1790. Full 7 pages.
George Washington delivered the first regular annual message before a joint session of Congress on January 8, 1790, in New York City, then the provisional U.S. capital. In 1801, Thomas Jefferson discontinued the practice of delivering the address in person, regarding it as too monarchical (similar to the Speech from the Throne). Instead, the address was written and then sent to Congress to be read by a clerk until 1913 when Woodrow Wilson re-established the practice despite some initial controversy. However, there have been exceptions to this rule. Presidents during the latter half of the 20th century[who?] have sent written State of the Union addresses. The last President to do this was Jimmy Carter in 1981, after his defeat by Ronald Reagan and days before his term ended.[9]
For many years, the speech was referred to as "the President's Annual Message to Congress".[10] The actual term "State of the Union" first emerged in 1934 when Franklin D. Roosevelt used the phrase, becoming its generally accepted name since 1947.[10]
Franklin Delano Roosevelt
State of the Union (Four Freedoms) (January 6, 1941)
Franklin Delano Roosevelt's January 6, 1941 State of the Union Address introducing the theme of the Four Freedoms (starting at 32:02)
Problems playing this file? See media help.
Prior to 1934, the annual message was delivered at the end of the calendar year, in December. The ratification of the 20th Amendment on January 23, 1933, changed the opening of Congress from early March to early January, affecting the delivery of the annual message. Since 1934, the message or address has been delivered to Congress in January or February.
The Twentieth Amendment also established January 20 as the beginning of the presidential term. In years when a new president is inaugurated, the outgoing president may deliver a final State of the Union message, but none has done so since Jimmy Carter sent a written message in 1981. In 1953 and 1961, Congress received both a written State of the Union message from the outgoing president and a separate State of the Union speech by the incoming president. Since 1989, in recognition that the responsibility of reporting the State of the Union formally belongs to the president who held office during the past year, newly inaugurated Presidents have not officially called their first speech before Congress a "State of the Union" message.
In 1936, President Roosevelt set a precedent when he delivered the address at night. Only once before—when Woodrow Wilson asked Congress to order the U.S. into World War I—had a sitting president addressed Congress at night.[11]
The text of the first page of Ronald Reagan's first State of the Union Address, given January 26, 1982
Warren Harding's 1922 speech was the first to be broadcast on radio, albeit to a limited audience,[12] while Calvin Coolidge's 1923 speech was the first to be broadcast across the nation.[2] Harry S. Truman's 1947 address was the first to be broadcast on television. Lyndon B. Johnson's address in 1965 was the first delivered in the evening.[12] Three years later, in 1968, television networks in the United States, for the first time, imposed no time limit for their coverage of a State of the Union address. Delivered by Lyndon B. Johnson, this address was followed by extensive televised commentary by, among others, Daniel Patrick Moynihan and Milton Friedman.[13] Ronald Reagan's 1986 State of the Union Address is the only one to have been postponed. He had planned to deliver it on January 28, 1986 but postponed it for a week after learning of the Space Shuttle Challenger disaster and instead addressed the nation on the day's events.[14][15] Bill Clinton's 1997 address was the first broadcast available live on the World Wide Web.[16]
Delivery of the speech[edit]
A formal invitation is made by the Speaker of the House to the President several weeks before each State of the Union Address.[17][18]
Invitations[edit]
Every member of Congress can bring one guest to the State of the Union address. The President may invite up to 24 guests with the First Lady in her box. The Speaker of the House may invite up to 24 guests in the Speaker’s box. Seating for Congress on the main floor is by a first-in, first-served basis with no reservations. The Cabinet, Supreme Court justices, members of the Diplomatic Corps, and Joint Chiefs have reserved seating.
Protocol of entry into House chamber[edit]
By approximately 8:30 pm on the night of the address, the members of the House have gathered in their seats for the joint session.[19] Then, the Deputy Sergeant at Arms addresses the Speaker and loudly announces the Vice President and members of the Senate, who enter and take the seats assigned for them.[19]
The Speaker, and then the Vice President, specify the members of the House and Senate, respectively, who will escort the President into the House chamber.[19] The Deputy Sergeant at Arms addresses the Speaker again and loudly announces, in order, the Dean of the Diplomatic Corps, the Chief Justice of the United States and the Associate Justices, and the Cabinet, each of whom enters and takes their seats when called.[19] The justices take the seats nearest to the Speaker's rostrum and adjacent to the sections reserved for the Cabinet and the members of the Joint Chiefs of Staff.[20]
The Sergeants at Arms of the House (left) and Senate (right) wait at the doorway to the House chamber before President Barack Obama enters to deliver the 2011 State of the Union Address.
Just after 9 pm, as the President reaches the door to the chamber,[21] the House Sergeant at Arms stands just inside the doors, faces the Speaker, and waits until the President is ready to enter the chamber.[20] When the President is ready, the Sergeant at Arms always announces his entrance, loudly stating the phrase: "Mister Speaker, the President of the United States!"[21]
As applause and cheering begins, the President slowly walks toward the Speaker's rostrum, followed by members of his Congressional escort committee.[21] The President's approach is slowed by pausing to shake hands, hug, kiss, and autograph copies of his speech for Members of Congress.[20] After he takes his place at the House Clerk's desk,[21] he hands two manila envelopes, previously placed on the desk and containing copies of the speech, to the Speaker and Vice President.
After continuing applause from the attendees has diminished, the Speaker introduces the President to the Representatives and Senators, stating: "Members of Congress, I have the high privilege and distinct honor of presenting to you the President of the United States."[20][21] This leads to a further round of applause and, eventually, the beginning of the address by the President.[21]
At close of the ceremony, attendees leave on their own accord. The Sergeants at Arms guides the President out of the Chamber. Some politicians stay to shake hands with and congratulate the President on his way out.
Designated survivor and other logistics[edit]
Customarily, one cabinet member (the designated survivor) does not attend the speech, in order to provide continuity in the line of succession in the event that a catastrophe disables the President, the Vice President, and other succeeding officers gathered in the House chamber. Additionally, since the September 11 attacks in 2001, a few members of Congress have been asked to relocate to undisclosed locations for the duration of the speech to form a rump Congress in the event of a disaster.[22] Since 2003, each chamber of Congress has formally named a separate designated survivor.[23][24]
President George W. Bush with Senate President (U.S. Vice President) Dick Cheney and House Speaker Nancy Pelosi during the 2007 State of the Union address. 2007 marked the first time that a woman had occupied the Speaker of the House chair. (audio only)
Both the Speaker and the Vice President sit at the Speaker's desk, behind the President for the duration of the speech. If either is unavailable, the next highest-ranking member of the respective house substitutes. Once the chamber settles down from the President's arrival, the Speaker officially presents the President to the joint session of Congress. The President then delivers the speech from the podium at the front of the House Chamber.
In the State of the Union the President traditionally outlines the administration's accomplishments over the previous year, as well as the agenda for the coming year, often in upbeat and optimistic terms.[25] Since the 1982 address, it has also become common for the President to honor special guests sitting in the gallery, such as American citizens or visiting heads of state. During that 1982 address, President Ronald Reagan acknowledged Lenny Skutnik for his act of heroism following the crash of Air Florida Flight 90.[26] Since then, the term "Lenny Skutniks" has been used to refer to individuals invited to sit in the gallery, and then cited by the President, during the State of the Union.[27][28]
State of the Union speeches usually last a little over an hour, partly because of the large amounts of applause that occur from the audience throughout. The applause is often political in tone, with many portions of the speech being applauded only by members of the President's own party. As non-political officeholders, members of the Supreme Court or the Joint Chiefs of Staff rarely applaud in order to retain the appearance of political impartiality. In recent years, the presiding officers of the House and the Senate, the Speaker and the Vice President, respectively, have departed from the neutrality expected of presiding officers of deliberative bodies, as they, too, stand and applaud in response to the remarks of the President with which they agree.
For the 2011 address, Senator Mark Udall of Colorado proposed a break in tradition wherein all members of Congress sit together regardless of party, as well as the avoiding of standing;[29] this was in response to the 2011 Tucson Shooting in which Representative Gabrielle Giffords was shot and wounded in an assassination attempt. This practice was also repeated during the 2012 address and every address after.[30]
Opposition response[edit]
Main article: Response to the State of the Union address
Since 1966,[31] the speech has been followed on television by a response or rebuttal by a member of the major political party opposing the President's party. The response is typically broadcast from a studio with no audience. In 1970, the Democratic Party put together a TV program with their speech to reply to President Nixon, as well as a televised response to Nixon's written speech in 1973.[32] The same was done by Democrats for President Reagan's speeches in 1982 and 1985. The response is not always produced in a studio; in 1997, the Republicans for the first time delivered the response in front of high school students.[33] In 2004, the Democratic Party's response was also delivered in Spanish for the first time, by New Mexico Governor Bill Richardson.[34] In 2011, Minnesota Congresswoman Michele Bachmann also gave a televised response for the Tea Party Express, a first for a political movement.[35]
Significance[edit]
Although much of the pomp and ceremony behind the State of the Union address is governed by tradition rather than law, in modern times, the event is seen as one of the most important in the US political calendar. It is one of the few instances when all three branches of the US government are assembled under one roof: members of both houses of Congress constituting the legislature, the President's Cabinet constituting the executive, and the Chief Justice and Associate Justices of the Supreme Court constituting the judiciary. In addition, the military is represented by the Joint Chiefs of Staff, while foreign governments are represented by the Dean of the Diplomatic Corps. The address has also been used as an opportunity to honor the achievements of some ordinary Americans, who are typically invited by the President to sit with the First Lady.[28]
Local versions[edit]
Certain states have a similar annual address given by the governor. For most of them, it is called the State of the State address. In Iowa, it is called the Condition of the State Address; in Kentucky, Massachusetts, Pennsylvania, and Virginia, the speech is called the State of the Commonwealth address. The mayor of Washington, D.C. gives a State of the District address. American Samoa has a State of the Territory address given by the governor. Puerto Rico has a State Address given by the governor.
Some cities or counties also have an annual State of the City Address given by the mayor, county commissioner or board chair, including Sonoma County, California; Orlando, Florida; Cincinnati, Ohio; New Haven, Connecticut; Parma, Ohio; Detroit, Michigan; Seattle, Washington; Birmingham, Alabama; Boston, Massachusetts; Los Angeles, California; Buffalo, New York; Rochester, New York; San Antonio, Texas; McAllen, Texas; and San Diego, California. The Mayor of the Metropolitan Government of Nashville and Davidson County in Nashville, Tennessee gives a speech similar called the State of Metro Address. Some university presidents give a State of the University address at the beginning of every academic term.[36][37] Private companies usually have a "State of the Corporation" or "State of the Company" address given by the respective CEO.[38]
The State of the Union model has also been adopted by the European Union,[39] and in France since the presidency of Emmanuel Macron.
Historic speeches[edit]
This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2018) (Learn how and when to remove this template message)
Play media
Roosevelt's Second Bill of Rights (excerpt)
President James Monroe first stated the Monroe Doctrine during his seventh annual State of the Union Address to Congress on December 2, 1823. It became a defining moment in the foreign policy of the United States and one of its longest-standing tenets, and would be invoked by many U.S. statesmen and several U.S. presidents, including Theodore Roosevelt, John F. Kennedy, and Ronald Reagan.
The Four Freedoms were goals first articulated by Franklin D. Roosevelt on January 6, 1941. In an address known as the Four Freedoms speech, he proposed four fundamental freedoms that people "everywhere in the world" ought to enjoy: freedom of speech and expression, freedom of worship, freedom from want, and freedom from fear.
During his State of the Union Address on January 11, 1944, FDR proposed the Second Bill of Rights. Roosevelt's argument was that the "political rights" guaranteed by the constitution and the Bill of Rights had "proved inadequate to assure us equality in the pursuit of happiness".
During his State of the Union address on January 8, 1964, Lyndon B. Johnson introduced legislation that would come to be known as the "War on Poverty". This legislation was proposed by Johnson in response to a national poverty rate of around nineteen percent. The speech led the United States Congress to pass the Economic Opportunity Act, which established the Office of Economic Opportunity (OEO) to administer the local application of federal funds targeted against poverty.
During his State of the Union address on January 15, 1975, Gerald R. Ford very bluntly stated that "the state of the Union is not good: Millions of Americans are out of work... We depend on others for essential energy. Some people question their Government's ability to make hard decisions and stick with them; they expect Washington politics as usual." Ford said he didn't "expect much, if any, applause. The American people want action, and it will take both the Congress and the President to give them what they want. Progress and solutions can be achieved, and they will be achieved."
George W. Bush delivers the 2002 State of the Union
In his 2002 State of the Union Address, President George W. Bush identified North Korea, Iran, and Iraq as representing significant threats to the United States. He said, "States like these and their terrorist allies constitute an axis of evil, arming to threaten the peace of the world". In this speech, he would outline the objectives for the War on Terror.
TV ratings[edit]
Television ratings for recent State of the Union Addresses were:[40][41][42]
Date
President
Viewers,
millions
Households,
millions
Rating
Networks
1/30/2018 Donald Trump 45.551 32.168 26.9 ABC, CBS, FOX, NBC, ESTRELLA, TELEMUNDO, UNIVISION, CNN, FOX BUSINESS, FOXNC, MSNBC, PBS
2/28/2017 Donald Trump 47.741 33.857 28.7 ABC, CBS, FOX, NBC, UNIVISION, PBS, CNN, FOX BUSINESS, FOXNC, MSNBC, NBC UNIVERSO
1/12/2016 Barack Obama 31.334 23.040 19.6 ABC, AL JAZEERA AMERICA, AZTECA, CBS, CNN, FOX, FOX BUSINESS, FOXNC, GALAVISION, MSNBC, NBC, NBC UNIVERSO, UNIVISION**
1/20/2015 Barack Obama 31.710 23.137 19.9 ABC, AL JAZEERA AMERICA, AZTECA, CBS, CNN, FOX, FOX BUSINESS, FOXNC, GALAVISION, MSNBC, MUNDOFOX, NBC, UNIVISION**
1/28/2014 Barack Obama 33.299 23.949 20.7 CBS, ABC, NBC, FOX, AZTECA, FOX BUSINESS, FOXNC, CNN, MSNBC, CNBC, AL JAZEERA AMERICA, GALAVISION, MUN2, UNIVISION**
2/12/2013 Barack Obama 33.497 24.767 21.8 FOX, ABC, CBS, NBC, PBS, AZTECA, UNIVISION, MFX, CNBC, CNN, FOX BUSINESS, FOXNC, MSNBC, CURRENT, CENTRIC, GALAVISION
1/24/2012 Barack Obama 37.752 27.569 24.0 ABC, CBS, FOX, NBC, TELEMUNDO, TF, UNIVISION, CNBC, CNN, FOX BUSINESS, FOXNC, GALAVISION, MSNBC, MUN2
1/25/2011 Barack Obama 42.789 30.871 26.6 ABC, CBS, FOX, NBC, TELEMUNDO, UNIVISION, CNN, CENTRIC, CNBC, FOXNC, MSNBC
1/27/2010 Barack Obama 48.009 34.182 29.8 ABC, CBS, FOX, NBC, TELEMUNDO, UNIVISION, CNN, BET, CNBC, FOXNC, MSNBC
2/24/2009 Barack Obama 52.373 37.185 32.5 ABC, CBS, FOX, NBC, CNBC, CNN, FOXNC, MSNBC, TELEMUNDO, UNIVISION
1/28/2008 George W. Bush 37.515 27.702 24.7 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC, TELEMUNDO**, UNIVISION
1/24/2007 George W. Bush 45.486 32.968 29.6 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC, TELEMUNDO, UNIVISION
2/01/2006 George W. Bush 43.179 30.528 31.2 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC, TELEMUNDO, AZTECA AMERICA, TELFUTURA
2/02/2005 George W. Bush 39.432 28.359 35.3 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC, TELEMUNDO, TELEFUTURA
1/20/2004 George W. Bush 43.411 30.286 28.0 ABC, CBS, FOX, NBC, CNN, CNBC, FOXNC, MSNBC
1/28/2003 George W. Bush 62.061 41.447 38.8 ABC, CBS, FOX, NBC, CNN, CNBC, FOXNC, MSNBC
1/29/2002 George W. Bush 51.773 35.547 33.6 ABC, CBS, FOX, NBC, CNN, CNBC, FOXNC, MSNBC
2/27/2001 George W. Bush 39.793 28.201 27.6 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC
1/27/2000 Bill Clinton 31.478 22.536 22.4 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC
1/19/1999 Bill Clinton 43.500 30.700 31.0 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC
1/27/1998 Bill Clinton 53.077 36.513 37.2 ABC, CBS, FOX, NBC, CNN, FOXNC, MSNBC, CNBC
2/04/1997 Bill Clinton 41.100 27.600 28.4 ABC, CBS, FOX, NBC, CNN
1/23/1996 Bill Clinton 40.900 28.400 29.6 ABC, CBS, FOX, NBC, CNN
1/24/1995 Bill Clinton 42.200 28.100 29.5 ABC, CBS, NBC, CNN
1/25/1994 Bill Clinton 45.800 31.000 32.9 ABC, CBS, NBC, CNN
2/17/1993 Bill Clinton 66.900 41.200 44.3 ABC, CBS, NBC, CNN
Notes
The 1993, 2001, 2009 and 2017 addresses were not, officially, State of the Union addresses, but rather addresses to a joint session Congress because in those years the presidents were in office for only a few weeks at the time the speech was given.[2][42]
**Tape delayed[42]
See also[edit]
List of joint sessions of the United States Congress
State Opening of Parliament
United States presidential address
References[edit]
^ Jump up to: a b c "State of the Union Address | US House of Representatives: History, Art & Archives". history.house.gov. Retrieved January 28, 2018.
^ Jump up to: a b c Diaz, Daniella (February 28, 2017). "Why Trump's Tuesday speech isn't a State of the Union address". CNN. Retrieved February 28, 2017.
Jump up ^ "Ben's Guide to U.S. Government". United States Government Printing Office. Archived from the original on February 25, 2009.
Jump up ^ "31.7 Million Viewers Tune In To Watch Pres. Obama's State of the Union Address". The Nielsen Company (Press release). January 21, 2015. On Tuesday, Jan. 20, 2015, President Barack Obama delivered his annual State of the Union address. The address was carried live from 9:00 p.m. to 10:15 p.m. on 13 networks and tape-delayed on Univision.
Jump up ^ Vasan Kesavan and J. Gregory Sidak (2002). "The Legislator-In-Chief". William and Mary Law Review. 44 (1). Retrieved June 28, 2012.
^ Jump up to: a b c The President's State of the Union Address: Tradition, Function, and Policy Implications (PDF). Congressional Research Service. January 24, 2014. p. 2.
Jump up ^ Jackson, David (January 11, 2013). "Obama State of the Union set for Feb. 12". USA Today.
Jump up ^ "State of the Union Addresses and Messages: research notes by Gerhard Peters". The American Presidency Project (APP). Retrieved 24 January 2017.
Jump up ^ Peters, Gerhard. "State of the Union Messages". The American Presidency Project. Retrieved September 25, 2006.
^ Jump up to: a b Kolakowski, Michael & Neale, Thomas H. (March 7, 2006). "The President's State of the Union Message: Frequently Asked Questions" (PDF). Congressional Research Service Report for Congress. Retrieved January 28, 2010.
Jump up ^ "President to Appear Before Congress: Message to be Delivered Friday night". Fairbanks Daily News-Miner. Associated Press. January 2, 1936. p. A1.
^ Jump up to: a b Robert Yoon, CNN Political Research Director (February 12, 2013). "State of the Union firsts". CNN. Retrieved September 29, 2017.
Jump up ^ Kurlansky, Mark (2004). 1968: The Year That Rocked the World. New York: Ballantine. p. 44. ISBN 0-9659111-4-4.
Jump up ^ "Address to the nation on the Challenger disaster". Ronald Reagan Presidential Library. Retrieved July 4, 2006.
Jump up ^ Weinraub, Bernard (January 29, 1986). "The Shuttle Explosion: Reagan Postpones State of the Union Speech". The New York Times. p. A9.
Jump up ^ Office of the Clerk. Joint Meetings, Joint Sessions, and Inaugurations. House History. United States House of Representatives. Archived from the original on January 18, 2011.
Jump up ^ "Speaker Boehner Extends President Obama Formal Invitation to Deliver State of the Union Address". Speaker Boehner's Press Office (Press release). January 11, 2011.
Jump up ^ "State of the Union 2015". Speaker Boehner's Press Office (Press release). December 19, 2014.
^ Jump up to: a b c d "Joint Session of Congress Pursuant to House Concurrent Resolution 228 to Receive a Message from the President" (PDF). Congressional Record: H414. January 27, 2010.
^ Jump up to: a b c d "President Delivers State of the Union Address" (Transcript). CNN. January 28, 2008.
^ Jump up to: a b c d e f "Joint Session of Congress Pursuant to House Concurrent Resolution 228 to Receive a Message from the President" (PDF). Congressional Record: H415. January 27, 2010.
Jump up ^ Roberts, Roxanne (September 20, 2016). "The truth behind the 'designated survivor,' the president of the post-apocalypse". Washington Post. Retrieved January 31, 2018.
Jump up ^ Schultheis, Emily (February 28, 2017). "Joint session 2017: The history of the "designated survivor"". CBS News. Retrieved January 31, 2018.
Jump up ^ Oritz, Erik (January 30, 2018). "Designated survivors recount nights as doomsday presidents". NBC News. Retrieved January 31, 2018.
Jump up ^ Widmer, Ted (January 31, 2006). "The State of the Union Is Unreal". The New York Times. Retrieved January 22, 2007.
Jump up ^ O'Keefe, Ed (January 24, 2012). "Three decades of 'Skutniks' began with a federal employee". Washington Post. Retrieved January 26, 2012.
Jump up ^ Wiggin, Addison (January 25, 2011). "Small Business Owners Should Be Obama's Lenny Skutnik". Forbes. Retrieved January 24, 2012.
^ Jump up to: a b Clines, Francis X. (August 24, 1996). "Bonding as New Political Theater: Bring On the Babies and Cue the Yellow Dog". The New York Times. Retrieved January 24, 2012.
Jump up ^ Epstein, Jennifer (January 13, 2011). "Mark Udall wants parties together at State of the Union". Politico.
Jump up ^ Hennessey, Kathleen (January 21, 2012). "Rival parties to mix it up – nicely – at State of the Union". Los Angeles Times.
Jump up ^ Office of the Clerk. "Opposition Responses to State of the Union Messages (1966–Present)". United States House of Representatives. Retrieved January 23, 2007.
Jump up ^ Frum, David (2000). How We Got Here: The '70s. New York: Basic Books. p. 47. ISBN 0-465-04195-7.
Jump up ^ Sincere, Richard E., Jr. (February 1997). "O.J., J.C., and Bill: Reflections on the State of the Union". Metro Herald. Archived from the original on July 31, 2002. Retrieved January 23, 2007. Watts told his audience—about 100 high school students from the CloseUp Foundation watched in person, while a smaller number watched on television at home—that he is 'old enough to remember the Jim Crow' laws that affected him and his family while he grew up in a black neighborhood in small-town Oklahoma.
Jump up ^ York, Byron (January 21, 2004). "The Democratic Response You Didn't See". National Review. Retrieved January 23, 2007. And then there was the Spanish-language response—the first ever—delivered by New Mexico governor, and former Clinton energy secretary, Bill Richardson.
Jump up ^ "Michele Bachmann offers Tea Party response to President Obama's State of the Union Address". The Washington Post. January 26, 2011. Retrieved 15 January 2015.
Jump up ^ "UNH State of the University 2015". The University of New Hampshire (Press release). February 17, 2015.
Jump up ^ "State of the University 2015". Santa Clara University (Press release). February 19, 2015.
Jump up ^ Goldman, Jeremy (January 20, 2015). "Why Your Company Deserves a 'State of the Union' Address". Inc.
Jump up ^ "EU has survived economic crisis, Barroso says in first State of Union address". EUobserver.com. September 7, 2010.
Jump up ^ "2018 State of The Union Address TV Ratings". Nielsen. 2018-01-31. Retrieved 2018-01-31.
Jump up ^ "2017 State of The Union Address TV Ratings". Nielsen. 2017-02-28. Retrieved 2018-01-11.
^ Jump up to: a b c "2016 State of The Union Address TV Ratings". Nielsen. 2016-01-13. Retrieved 2018-01-11.
External links[edit]
Wikimedia Commons has media related to State of the Union.
Wikisource has original text related to this article:
Portal:State of the Union Speeches by United States Presidents
The American Presidency Project: State of the Union Messages "Established in 1999 as a collaboration between John Woolley and Gerhard Peters at the University of California, Santa Barbara," currently (January 2010), the APP "archives contain 87,448 documents related to the study of the Presidency".
State of the Union videos and transcripts at C-SPAN (since 1945)
State of the Union (Visualizations, Statistical Analysis, and Searchable texts)
State of the Union Addresses of American Presidents (1790–2002) (in downloadable electronic file formats)
State of the Union Addresses of American Presidents (1790–2006) (HTML format)
Searchable visualizations of all State of the Union Addresses of American Presidents (1790–2009)
The State of the Union Text and PDF at U.S. Government Printing Office (GPO) from January 28, 1992 to current date
Top 10 State of the Union Addresses, RealClearPolitics.com
The 2013 State of the Union Address on YouTube (1:01:02)
State of the Union Speeches by United States Presidents
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text:
Patient Self-Determination Act
From Wikipedia, the free encyclopedia
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The Patient Self-Determination Act (PSDA) was passed by the United States Congress in 1990 as an amendment to the Omnibus Budget Reconciliation Act of 1990. Effective on December 1, 1991, this legislation required many hospitals, nursing homes, home health agencies, hospice providers, health maintenance organizations (HMOs), and other health care institutions to provide information about advance health care directives to adult patients upon their admission to the healthcare facility.[1][2] This law does not apply to individual physicians.
Because the 1991 PSDA does not apply to individual physicians, private clinics and practices, most of which are incorporated for-profit organizations, the problem of cruel over treatment for profit of the elderly on Medicare/Medicaid was not controlled to the extent that Congress hoped would be possible when the states would implement the goals of the 1991 PSDA in state laws. (Recently, in 2012, the newspapers have revealed that The United States Department of Health and Human Services and the Department of Justice have cooperated to prosecute over treatment of patients under the federal False Claims Act.) The goals of the 1991 PSDA are covered in the PURPOSE section, below.
Section 1233 of the proposed America's Affordable Health Choices Act of 2009 (H.R. 3200) would have authorized reimbursements for physician counseling regarding advance directives (once every five years)[3] but it was not included in the Patient Protection and Affordable Care Act of 2010 because of controversy over what were characterized as "death panels."[4][5]
Unfortunately, because the law of the 1991 PSDA does not require or mandate the treating physicians—after an educated "terminal" prognosis that is shared with the patient—to seek informed consent from elderly and terminal Medicare/Medicaid patients for either Curative Care under Medicare or palliative care, transition to Hospice in the last six months of life (also paid or out of the Medicare purse), the goals of the PSDA are not realized. Patient self rationing of expensive medical care at the end of life through the process of the advance directive under the provisions of the 1991 PSDA is discouraged because the patients have not had end-of-life conversations with the treating physicians.
Contents
[hide]
1 Requirements
2 Purpose
3 References
4 Further reading
5 External links
Requirements[edit]
The requirements of the PSDA are as follows:
p
Patients are given written notice upon admission to the health care facility of their decision-making rights, and policies regarding advance health care directives in their state and in the institution to which they have been admitted. Patient rights include:
The right to facilitate their own health care decisions
The right to accept or refuse medical treatment
The right to make an advance health care directive
Facilities must inquire as to whether the patient already has an advance health care directive, and make note of this in their medical records.
Facilities must provide education to their staff and affiliates about advance health care directives.
Health care providers are not allowed to discriminately admit or treat patients based on whether or not they have an advance health care directive.
Purpose[edit]
The purpose of the Patient Self-Determination Act was/is to inform patients of their rights regarding decisions toward their own medical care, and ensure that these rights are communicated by the health care provider. Specifically, the rights ensured are those of the patient to dictate their future care (by means such as living will or power of attorney), should they become incapacitated.
The goals of the "purpose" of the Patient Self-Determination Act are/were (1) to prevent cruel over treatment of elderly/disabled Medicare/Medicaid patients for the profit motive and (2) to save money for Medicare and the private insurers in the form of the reduction of end-of-life costs for Medicare and the private insurers when elderly Medicare/Medicaid patients would ELECT/CHOOSE to refuse expensive ICU/CCU life-extending or life-saving treatments in the hospital in order to shorten their suffering unto a certain death. It was envisioned by the framers of the 1991 PSDA that the elderly/disabled on Medicare/Medicaid would die less expensively and more comfortably (out of pain) on the palliative care/Hospice Medicare Entitlement in their own personal residence or in the setting of a residential nursing home when the treating physicians consulted with them about their terminal diagnoses.
References[edit]
Jump up ^ Health Care Advance Directives - What is the Patient Self-Determination Act?. American Bar Association.
Jump up ^ What is the Patient Self-Determination Act?. Legal HelpMate.
Jump up ^ Advance Care Planning in Health Care Reform Legislation Archived 2010-07-13 at the Wayback Machine.. National Hospice and Paliative Care Organization.
Jump up ^ Robert Pear (December 25, 2010). "Obama Returns to End-of-Life Plan That Caused Stir". The New York Times.
Jump up ^ Robert Pear (January 4, 2011). "U.S. Alters Rule on Paying for End-of-Life Planning". The New York Times.
Further reading[edit]
Kring, Daria L. (October–December 2007). "The Patient Self-determination Act: has it reached the end of its life?" . JONA'S Healthcare Law, Ethics and Regulation. 9 (4): 125–33. doi:10.1097/01.NHL.0000300767.91800.17. PMID 18043329.
Leahman, Dee (July–August 2004). "Why the Patient Self-Determination Act has failed". North Carolina Medical Journal. 65 (4): 249–51. PMID 15481498.
Pope, Thaddeus Mason (Winter 1999). "The Maladaptation of Miranda to Advance Directives: A Critique of the Patient Self Determination Act". Health Matrix. 9 (1): 139–202. PMID 10538190. SSRN 174749  .
Ulrich, Lawrence P. (1998), "The Requirements of the Patient Self-Determination", The Patient Self-Determination Act: Meeting the Challenges in Patient Care
Walerius, Theresa; Hill, Pamela D.; Anderson, Mary Ann (November–December 2009). "Nurses' knowledge of Advance Directives, Patient Self-determination Act, and Illinois Advance Directive Law". Clinical Nurse Specialist. 23 (6): 316–20. doi:10.1097/NUR.0b013e3181be3273. PMID 19858904.
Yates, Jeffery L.; Glick, Henry R. (1997). "The failed Patient Self-Determination Act and policy alternatives for the right to die" . Journal of Aging & Social Policy. 9 (4): 29–50. doi:10.1300/J031v09n04_03. PMID 10186890.
External links[edit]
"The Patient Self-Determination Act (PSDA)". American Cancer Society: Treatment Topics & Resources. June 15, 2009. Archived from the original on February 22, 2010.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Patient_Self-Determination_Act&oldid=830355762"
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