Advance Directives and Medical Treatment at the End of Life

To assess the consequences of advance medical directives -- which explicitly specify a patient's preferences for one or more specific types of medical treatment in the event of a loss of competence we analyze the medical care of elderly Medicare beneficiaries who died between 1985-1995. We compare the care of patients from states that adopted laws enhancing incentives for compliance with advance directives and laws requiring the appointment of a health care surrogate in the absence of an advance directive to the care of patients from states that did not. We report three key findings. First, laws enhancing incentives for compliance significantly reduce the probability of dying in an acute care hospital. Second, laws requiring the appointment of a surrogate significantly increase the probability of receiving acute care in the last month of life, but decrease the probability of receiving nonacute care. Third, neither type of law leads to any savings in medical expenditures.