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June 22, 1994

Increasing Completion of Advance Directives

JAMA. 1994;271(24):1907. doi:10.1001/jama.1994.03510480031023

To the Editor.  —Dr Rubin and colleagues1 erroneously suggest that a simple intervention might increase the completion of proxy forms.Rubin et al claim to have increased use of proxy forms from 5.8% to 18.5%. They claim their data—particularly the very low baseline rate of completing proxy forms—are comparable with those of other studies. The studies they cite were conducted before the Cruzan ruling, which dramatically increased the use of proxy forms. For example, it has recently been reported that 19.8% of Massachusetts patients had a living will or proxy form during a period similar to that during which the Rubin study was conducted.2Rubin et al fail to cite other studies showing higher rates of completing living wills or proxy forms. One study showed 15% of adults over 65 years old had completed living wills.3 They also misquote the studies with which they do compare their