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Editorial
October 5, 2011

The Evolution of Advance Directives

JAMA. 2011;306(13):1485-1486. doi:10.1001/jama.2011.1430

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.

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