Hope for the Future: Achieving the Original Intent of Advance Directives

Abstract
Despite the hope that traditional advance directives would ensure that patient preferences are honored, numerous studies have found that only a minority (20 to 30 percent) of American adults have an advance directive and that these documents have limited effects on treatment decisions near the end of life, though more recent research suggests use may be higher at the end of life. In addition to a low completion rate, there are many reasons why traditional advance directives are less successful than originally hoped. These reasons include the following:

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