CONTEXT It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments. OBJECTIVE To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments. DESIGN, SETTING, AND PATIENTS Prospectively collected survey data from the Healt...

The ethical dimension of treating the elderly, including risk-benefit analysis, focuses mainly on quality of life and end-of-life issues. These include arguments on advance directives and the concept of extraordinary treatments. This paper looks more closely at the philosophical approach to aging in order to address questions on the direction of research and issues such as longevity and social ...

This report challenges commonly held beliefs about the financial and medical impact of older Americans during their last months of life. Written by physicians specializing in geriatrics, the report offers a wealth of data to refute seven misconceptions that currently influence U.S. health care policies: (1) that the growing number of older people has been the primary factor driving the rise in ...

Dilemmas about when psychiatric advance directives (PADs) should be overridden are complicated by conflicting legal frameworks that may nonetheless operate concurrently-a legal scheme based on decision-making capacity (or competency) set against a legal scheme based on civil commitment, in which the latter may "trump" the former. A single statute in which the strengths of both schemes are "fuse...

Current statutes enabling psychiatric advance directives (PADs) typically include provisions allowing override of patients' choices by treatment staff. Lest the purpose of the PAD be vitiated by too broad an application of the override mechanism, its use should be carefully limited. In inpatient settings, voluntary patients should have the right to decline treatments in advance, although not an...