Advance directives: keeping up with changing legislation.

1. All 50 states and the District of Columbia have advance directive legislation in place; however, the legislation varies greatly from state to state. Nurses, therefore, must constantly update their knowledge in order to stay current. 2. There are two significant new developments in right-to-die legislation: surrogate/family decision making, which allows close family members or friends to make treatment decisions for a patient who has not executed an advance directive; and nonhospital orders not to administer cardiopulmonary resuscitation, which ensure that death is not unnecessarily prolonged by emergency service personnel. 3. To provide the optimum protection of its citizens' right to die, each state should have all forms of advance directive legislation: living will, durable power of attorney for health care, surrogate/family decision making, and nonhospital order not to resuscitate. Even if all this legislation were to be passed, however, there would still be significant gaps in coverage.