This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
PEOPLE, physicians and patients alike, tend not to like to talk about death.
That may be why good compliance has yet to translate into success for a law requiring that everyone admitted to a hospital be told about their rights to advance directives and proxies.
Since the Patient Self-determination Act went into effect in November 1991, there apparently have not been many more people than before filling out legal documents that detail how they wish to be cared for or who should make decisions for them when they are unable to speak for themselves. Nor is there evidence of a measurable decrease in end-of-life health care costs, as proponents had hoped.
In most cases, people are merely handed written material that describes advance directives, asked if they have one, "and that's about it," says Alexandra Gekas, director of the American Hospital Association's National Society for Patient Representatives and Consumer Affairs.
Cotton P. Talk to People About Dying—They Can Handle It, Say Geriatricians and Patients. JAMA. 1993;269(3):321-322. doi:10.1001/jama.1993.03500030013002