Author Affiliation: Center for Gerontology and Health Care Research, Brown University, Providence, RI.
Having an advance directive, a living will, and a durable power of attorney1 has been proposed as means for a competent person
to legally assert his or her autonomy before he or she becomes unable to make
decisions. Whether promoting the completion of an advance directive saves
resources otherwise squandered on care not wanted by the dying patient remains
a tantalizing question.2,3 Medicine
and society are now faced with an aging population that is slowly dying of
chronic ailments and the question of whether too much is spent on the dying.
Such concerns have been fueled by the statistic that 28% of Medicare program
expenditures were accounted for by 6% of persons who died during that year.4
Teno JM. Advance Directives for Nursing Home ResidentsAchieving Compassionate, Competent, Cost-effective Care. JAMA. 2000;283(11):1481-1482. doi:10.1001/jama.283.11.1481