In 1990 the Patient Self-Determination Act became effective. The Patient Self-Determination Act was an act that required consumers to be proved with informed consent, information about their right to make advance health care decisions, and information about state laws that impact legal choices in making health care decision. In North America, it is required that all health care facilities notify any patient 18 and over about their right to have an advance directive in their medical records. Living wills, health care proxy, and power of attorney are all included in advances directives. The patient must be notified, in writing, by the facility to any and all federal laws that are for advance directives for the state they are living in. I believe that this is very beneficial to both the patient and facility; as well as the patient medical records. If any problems were to occur during a procedure or surgery, the doctors and any medical personnel would know exactly what the patient would want. For example, my Grandfather had open heart surgery and he signed a DNR also known as a “do not resuscitate” just in case his heart would stop during his surgery, he did not want any type of CPR preformed on him to bring him back to life. People will all have different reasons behind why they choose to have a DNR. If something were to happen, and they did not perform CPR on a patient who was dying, they would have a living will so that all of the patients last wishes were granted.