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Advance directives and medical treatment at the end of life

机译：生命尽头的预先指示和医疗

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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 and 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.
机译：为了评估高级医疗指示的后果-该医疗指示明确指定了患者在丧失能力时对一种或多种特定类型医疗的偏爱-我们分析了1985年至1995年之间死亡的老年Medicare受益人的医疗保健。比较那些通过法律加强奖励措施以遵守预先指示的州的患者的护理，以及需要在缺乏预先指示的情况下指定卫生保健代理人的法律来照顾那些没有采取措施的州。我们报告了三个主要发现。首先，加强合规激励措施的法律大大降低了在急诊医院死亡的可能性。其次，要求任命代理人的法律显着增加了生命最后一个月接受急性护理的可能性，但降低了接受非急性护理的可能性。第三，这两种法律都无法节省医疗费用。

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