Author Affiliations: Department of Critical Care Medicine, Program on Ethics and Decision Making in Critical Illness, Clinical Research, Investigation, Systems Modeling of Acute Illness (CRISMA) Center (Dr White) and Division of General Internal Medicine, Section on Palliative Care and Medical Ethics, Department of Medicine (Dr Arnold), University of Pittsburgh, Pittsburgh, Pennsylvania.
There are 2 widely known problems with end-of-life care in the United States. First, care often does not reflect patients' values and preferences. Second, end-of-life care constitutes a disproportionate amount of health care expenditures.1 There is a need to improve the value of health care spending because of changing economic and political climates and because Medicare and Medicaid costs account for nearly a quarter of the federal budget. Despite recognition that advance directives have conceptual limitations,2,3 their appeal persists because of the theoretical possibility that advance directives can simultaneously improve the patient centeredness of care and decrease health care expenditures near the end of life.
White DB, Arnold RM. The Evolution of Advance Directives. JAMA. 2011;306(13):1485–1486. doi:10.1001/jama.2011.1430
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