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Editorial |

Advance Directives for Nursing Home Residents:  Achieving Compassionate, Competent, Cost-effective Care

Joan M. Teno, MD, MS
JAMA. 2000;283(11):1481-1482. doi:10.1001/jama.283.11.1481.
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Having an advance directive, a living will, and a durable power of attorney1 has been proposed as means for a competent person to legally assert his or her autonomy before he or she becomes unable to make decisions. Whether promoting the completion of an advance directive saves resources otherwise squandered on care not wanted by the dying patient remains a tantalizing question.2,3 Medicine and society are now faced with an aging population that is slowly dying of chronic ailments and the question of whether too much is spent on the dying. Such concerns have been fueled by the statistic that 28% of Medicare program expenditures were accounted for by 6% of persons who died during that year.4

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