Is Informed Consent still central to medical ethics? The Patient Self-Determination Act, a federal law that went into effect in 1991, requires health care institutions to advise patients about their right to accept or refuse medical care and to offer them an opportunity to create an advance directive indicating their medical choices, should they become incompetent. Nevertheless, there is considerable evidence that patients and their designated health care proxies are not brought into decision making at the end of life in a timely and effective way. There are also some limits on what kind of information must be provided to patients. In the 1993 case of Arato v. Avedon, the California Supreme Court supported information sharing and patient-centered decision making, but ruled that doctors need not supply explicit statistical information about life expectancy to patients. Nonetheless, the concept of informed consent from Western political and ethical theories that place a high value on individual self - determination, remains a central principle in the U.S. Cultural groups who have different traditions may not share this value." (Levine, 2007, p. 20) Should informed consent be different for different cultures? Why or why not? How should medical professionals and health care organizations balance cultural preferences with full disclosure?