I found the editorial by Singer and Lowy1 very thought provoking with many interesting facts as well as ideas. However, it has been my experience that patients and their families are unwilling to take the initiative despite careful discussion in choosing to address an advanced health care directive. It is now nationwide policy in the United States to provide every patient who enters the hospital with information concerning advanced life and health care directives. It has been my experience that these are not very helpful in the care of the patient should he/she reach a critical illness. It is also my thinking that the proposed 5 billion dollars saved, at the authors' low-end estimation, is still probably an overestimation of what it would, in fact, save us.2
The patients who receive care in the intensive care units certainly comprise a large bulk of high technology, high expense medical
Wald MS. Dichotomy in Health Care Policy. Arch Intern Med. 1993;153(2):259. doi:10.1001/archinte.1993.00410020103010
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