Since the early 1990s, when Congress mandated the Patient Self-Determination Act of 1991, health care systems, nonprofits, and state governments have spent millions to generate initiatives and documents to help people express their end-of-life treatment goals. The purpose of advance directives—one’s legal end-of-life documents—is to ensure that patients with serious and terminal conditions receive medical care that matches their stated wishes—something health care professionals call “goal-concordant care.”
Most palliative care experts urge their friends, family, and patients to complete advance directives. Yet others point out that after 30 years of campaigns persuading people to write their living wills, more than 65 percent of adults still haven’t completed the documents and that research struggles to reveal a compelling reason to do so.