Advance directives were created in response to increasing medical technology.[2][3] Numerous studies have documented critical deficits in the medical care of the dying. Frequently, death in health care facilities – where 80% of all deaths occur[4][5][6] – is unnecessarily prolonged,[7] painful,[8] expensive,[9][10] and emotionally burdensome to both patients and their families.[11][12]
Aggressive medical intervention leaves nearly two million Americans confined to nursing homes,[13] and over 1.4 million Americans remain so frail as to survive only through the use of feeding tubes.[14] As many as 30,000 persons are kept alive in comatose and permanently vegetative states.[15][16]
Cost burdens to individuals and families are considerable. A national study found that: “In 20% of cases, a family member had to quit work;” 31% lost “all or most savings” (even though 96% had insurance); and “20% reported loss of [their] major source of income.”[17] Yet, studies indicate that 70-95% of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.[18][19]
As more and more Americans experienced the burdens and diminishing benefits of invasive and aggressive medical treatment in poor prognosis states – either directly (themselves) or through a loved one – pressure began to mount to devise ways to avoid the suffering and costs associated with treatments one did not want in personally untenable situations.[3] The first formal response was the living will.
