1 40 9 Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1377/hlthaff.24.4.961" target="_blank" rel="noreferrer">http://doi.org/10.1377/hlthaff.24.4.961</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The costs of nonbeneficial treatment in the intensive care setting Publisher An entity responsible for making the resource available Health Affairs Date A point or period of time associated with an event in the lifecycle of the resource 2005 Subject The topic of the resource Female; Humans; Male; United States; Patient Discharge; Adult; Medical Futility; Middle Aged; Length of Stay; Dissent and Disputes; Survival Analysis; Empirical Approach; Death and Euthanasia; decision making; ICU Decision Making; Health Care and Public Health; Hospital Costs/statistics & numerical data; Ethics Consultation/utilization; Intensive Care Units/economics/ethics; Intensive Care/economics/ethics/utilization; Life Support Care/economics/ethics/utilization Creator An entity primarily responsible for making the resource Gilmer T; Schneiderman LJ; Teetzel H; Blustein J; Briggs K; Cohn F; Cranford R; Dugan D; Kamatsu G; Young E Description An account of the resource Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care. 2005 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1377/hlthaff.24.4.961" target="_blank" rel="noreferrer">10.1377/hlthaff.24.4.961</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 2005 Adult Backlog Blustein J Briggs K Cohn F Cranford R Death and Euthanasia Decision Making Dissent And Disputes Dugan D Empirical Approach Ethics Consultation/utilization Female Gilmer T Health Affairs Health Care and Public Health Hospital Costs/statistics & numerical data Humans ICU Decision Making Intensive Care Units/economics/ethics Intensive Care/economics/ethics/utilization Journal Article Kamatsu G Length Of Stay Life Support Care/economics/ethics/utilization Male Medical Futility Middle Aged Patient Discharge Schneiderman LJ Survival Analysis Teetzel H United States Young E Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1016/j.spen.2004.03.012" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.spen.2004.03.012</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ethical issues in pediatric critical care neurology Publisher An entity responsible for making the resource available Seminars In Pediatric Neurology Date A point or period of time associated with an event in the lifecycle of the resource 2004 Subject The topic of the resource Child; Humans; Pediatrics; Medical Futility; Research; Informed Consent; Ethics; Medical; Professional Patient Relationship; Death and Euthanasia; ICU Decision Making; Biomedical and Behavioral Research; Critical Care/ethics; Health Care and Public Health; Intensive Care Units/ethics; Jurisprudence; Neurology/ethics Creator An entity primarily responsible for making the resource Shevell M Description An account of the resource Ethical issues in the critical care unit frequently arise in children with neurological problems. These ethical issues frequently challenge our medical management of such cases and can be quite problematic. This article reviews key ethical issues that may arise including informed consent, futility, justice/rationing, clinical research conduct and the severely compromised patient who is in either a permanent vegetative or minimally conscious state. 2004 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1016/j.spen.2004.03.012" target="_blank" rel="noreferrer">10.1016/j.spen.2004.03.012</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 2004 Backlog Biomedical and Behavioral Research Child Critical Care/ethics Death and Euthanasia Ethics Health Care and Public Health Humans ICU Decision Making Informed Consent Intensive Care Units/ethics Journal Article Jurisprudence Medical Medical Futility Neurology/ethics Pediatrics Professional Patient Relationship Research Seminars In Pediatric Neurology Shevell M Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1046/j.1532-5415.2002.50622.x" target="_blank" rel="noreferrer">http://doi.org/10.1046/j.1532-5415.2002.50622.x</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Managing end-of-life care: comparing the experiences of terminally Ill patients in managed care and fee for service Publisher An entity responsible for making the resource available Journal Of The American Geriatrics Society Date A point or period of time associated with an event in the lifecycle of the resource 2002 Subject The topic of the resource Female; Humans; Male; Physician-Patient Relations; Adult; Aged; Middle Aged; Health Services Accessibility; Outcome Assessment (Health Care); adolescent; 80 and over; Empirical Approach; Non-U.S. Gov't; Professional Patient Relationship; Research Support; Caregivers/psychology; Death and Euthanasia; Comparative Study; Health Services/utilization; Health Care and Public Health; Fee-for-Service Plans; Managed Care Programs; Terminal Care/economics Creator An entity primarily responsible for making the resource Slutsman J; Emanuel LL; Fairclough D; Bottorff D; Emanuel EJ Description An account of the resource There have been no published empirical studies comparing the experiences of terminally ill patients in managed care organizations (MCOs) and those in fee for service (FFS). This investigation represents the first empirical study to systematically compare substantive outcomes between populations of terminally ill patients enrolled in MCO and FFS healthcare delivery systems. The investigators interviewed 988 patients whose physicians judged them to be terminally ill and 893 of their caregivers. Outcomes assessments were made in six domains: patient-physician relationship; access to care and use of health care; prevalence of symptoms; and planning for end-of-life care, care needs, and economic burdens. Overall, the two populations of terminally ill patients were found to have comparable outcomes, but several significant differences were present. MCO patients were more likely than their FFS counterparts to use an inconvenient hospital (P =.02), spend more than 10% of their income on medical care (P =.02), and have been bedridden more than 50% of the time during the last 4 weeks of life (P =.03). Caregivers of MCO patients were as likely as the caregivers of FFS patients to report a substantial caregiving burden (P =.59). Despite concerns about the threats of MCOs to the physician-patient relationship, few differences in the quality of the relationship between the two cohorts were found. Finally, terminally ill patients in MCOs did not show better experiences than those in FFS on any outcome measure. Additional research is required to explore how MCOs may improve upon the care available to dying patients. 2002 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1046/j.1532-5415.2002.50622.x" target="_blank" rel="noreferrer">10.1046/j.1532-5415.2002.50622.x</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 2002 80 And Over Adolescent Adult Aged Backlog Bottorff D Caregivers/psychology Comparative Study Death and Euthanasia Emanuel EJ Emanuel LL Empirical Approach Fairclough D Fee-for-Service Plans Female Health Care and Public Health Health Services Accessibility Health Services/utilization Humans Journal Article Journal Of The American Geriatrics Society Male Managed Care Programs Middle Aged Non-U.S. Gov't Outcome Assessment (health Care) Physician-patient Relations Professional Patient Relationship Research Support Slutsman J Terminal Care/economics Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1136/jme.2002.001537" target="_blank" rel="noreferrer">http://doi.org/10.1136/jme.2002.001537</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Certainty and mortality prediction in critically ill children. Publisher An entity responsible for making the resource available Journal Of Medical Ethics Date A point or period of time associated with an event in the lifecycle of the resource 2004 Subject The topic of the resource Child; Humans; Intensive Care Units; Medical Staff; Hospital Mortality; Prognosis; Prospective Studies; Clinical Competence; Longitudinal Studies; Risk Assessment; Pediatric; Empirical Approach; Professional Patient Relationship; Death and Euthanasia; Hospital; Health Care and Public Health; Critical Illness/mortality Creator An entity primarily responsible for making the resource Marcin JP; Pretzlaff RK; Pollack MM; Patel KM; Ruttimann UE Description An account of the resource OBJECTIVES: The objective of this study is to investigate the relationship between a physician's subjective mortality prediction and the level of confidence with which that mortality prediction is made. DESIGN AND PARTICIPANTS: The study is a prospective cohort of patients less than 18 years of age admitted to a tertiary Paediatric Intensive Care Unit (ICU) at a University Children's Hospital with a minimum length of ICU stay of 10 h. Paediatric ICU attending physicians and fellows provided mortality risk predictions and the level of confidence associated with these predictions on consecutive patients at the time of multidisciplinary rounds within 24 hours of admission to the paediatric ICU. Median confidence levels were compared across different ranges of mortality risk predictions. RESULTS: Data were collected on 642 of 713 eligible patients (36 deaths, 5.6%). Mortality predictions greater than 5% and less than 95% were made with significantly less confidence than those predictions 95%. Experience was associated with greater confidence in prognostication. CONCLUSIONS: We conclude that a physician's subjective mortality prediction may be dependent on the level of confidence in the prognosis; that is, a physician less confident in his or her prognosis is more likely to state an intermediate survival prediction. Measuring the level of confidence associated with mortality risk predictions (or any prognostic assessment) may therefore be important because different levels of confidence may translate into differences in a physician's therapeutic plans and their assessment of the patient's future. 2004 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1136/jme.2002.001537" target="_blank" rel="noreferrer">10.1136/jme.2002.001537</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 2004 Backlog Child Clinical Competence Critical Illness/mortality Death and Euthanasia Empirical Approach Health Care and Public Health Hospital Hospital Mortality Humans Intensive Care Units Journal Article Journal of Medical Ethics Longitudinal Studies Marcin JP Medical Staff Patel KM Pediatric Pollack MM Pretzlaff RK Professional Patient Relationship Prognosis Prospective Studies Risk Assessment Ruttimann UE Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1136/jme.2003.007153" target="_blank" rel="noreferrer">http://doi.org/10.1136/jme.2003.007153</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coordinating the norms and values of medical research, medical practice and patient worlds-the ethics of evidence based medicine in orphaned fields of medicine Publisher An entity responsible for making the resource available Journal Of Medical Ethics Date A point or period of time associated with an event in the lifecycle of the resource 2004 Subject The topic of the resource Delivery of Health Care; Humans; Personal Autonomy; Attitude to Health; Clinical Competence; Ethics; Medical; Analytical Approach; Models; Theoretical; Health Care and Public Health; Social Responsibility; Allied Health Occupations/ethics; Cognitive Therapy/ethics; Evidence-Based Medicine/ethics; Integrated/ethics; Interprofessional Relations/ethics; Logic; Patient Care Team/ethics; Physical Therapy Modalities/ethics; Social Justice/ethics Creator An entity primarily responsible for making the resource Vos R; Willems D; Houtepen R Description An account of the resource Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency is state of the art medical science. What goes for the ethics of clinical trials goes for the ethics of medicine as a whole: anything that is scientifically doubtful is, other things being equal, ethically unacceptable. This particularly applies to so called orphaned fields of medicine, those areas where medical research is weak and diverse, where financial incentives are lacking, and where the evidence regarding the aetiology and treatment of disease is much less clear than in laboratory and hospital based medicine. Examples of such orphaned fields are physiotherapy, psychotherapy, medical psychology, and occupational health, which investigate complex syndromes such as RSI, whiplash, chronic low back pain, and chronic fatigue syndrome. It appears that the primary ethical problem in this context is the lack of attention to the orphaned fields. Although we agree that this issue deserves more attention as a matter of potential injustice, we want to argue that, in order to do justice to the interplay of heterogeneous factors that is so typical of the orphaned fields, other ethical models than justice are required. We propose the coordination model as a window through which to view the important ethical issues which relate to the communication and interaction of scientists, health care workers, and patients. 2004 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1136/jme.2003.007153" target="_blank" rel="noreferrer">10.1136/jme.2003.007153</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 2004 Allied Health Occupations/ethics Analytical Approach Attitude To Health Backlog Clinical Competence Cognitive Therapy/ethics Delivery of Health Care Ethics Evidence-Based Medicine/ethics Health Care and Public Health Houtepen R Humans Integrated/ethics Interprofessional Relations/ethics Journal Article Journal of Medical Ethics Logic Medical Models Patient Care Team/ethics Personal Autonomy Physical Therapy Modalities/ethics Social Justice/ethics Social Responsibility Theoretical Vos R Willems D Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1111/j.1532-5415.1998.tb01046.x" target="_blank" rel="noreferrer">http://doi.org/10.1111/j.1532-5415.1998.tb01046.x</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The future of the doctor-payer-patient relationship Publisher An entity responsible for making the resource available Journal Of The American Geriatrics Society Date A point or period of time associated with an event in the lifecycle of the resource 1998 Subject The topic of the resource Humans; Physician-Patient Relations; Philosophy; Ethics; Forecasting; Medical; Non-U.S. Gov't; Professional Patient Relationship; Research Support; Chronic Disease/therapy; Health Care and Public Health; Social Change; Managed Care Programs; Acute Disease/therapy; Commodification Creator An entity primarily responsible for making the resource Cassell EJ Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1111/j.1532-5415.1998.tb01046.x" target="_blank" rel="noreferrer">10.1111/j.1532-5415.1998.tb01046.x</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article Description An account of the resource 1998 1998 Acute Disease/therapy Backlog Cassell EJ Chronic Disease/therapy Commodification Ethics Forecasting Health Care and Public Health Humans Journal Article Journal Of The American Geriatrics Society Managed Care Programs Medical Non-U.S. Gov't Philosophy Physician-patient Relations Professional Patient Relationship Research Support Social Change Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.1136/adc.84.3.265" target="_blank" rel="noreferrer">http://doi.org/10.1136/adc.84.3.265</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Identifying futility in a paediatric critical care setting: a prospective observational study Publisher An entity responsible for making the resource available Archives Of Disease In Childhood Date A point or period of time associated with an event in the lifecycle of the resource 2001 Subject The topic of the resource Child; Female; Humans; Male; Intensive Care Units; Medical Futility; Prognosis; Prospective Studies; Euthanasia; Severity of Illness Index; Hospitals; Teaching; quality of life; Preschool; Empirical Approach; Death and Euthanasia; infant; ICU Decision Making; Pediatric/organization & administration; Patient Admission/statistics & numerical data; London; Health Care and Public Health; Critical Illness/classification; Cost Control; Passive/statistics & numerical data Creator An entity primarily responsible for making the resource Goh AY; Mok Q Description An account of the resource AIMS: To determine the extent of futile care provided to critically ill children admitted to a paediatric intensive care setting. METHODS: Prospective evaluation of consecutive admissions to a 20 bedded multidisciplinary paediatric intensive care unit of a North London teaching hospital over a nine month period. Three previously defined criteria for futility were used: (1) imminent demise futility (those with a mortality risk greater than 90% using the Paediatric Risk of Mortality (PRISM II) score); (2) lethal condition futility (those with conditions incompatible with long term survival); and (3) qualitative futility (those with unacceptable quality of life and high morbidity). RESULTS: A total of 662 children accounting for 3409 patient bed days were studied. Thirty four patients fulfilled at least one of the criteria for futility, and used a total of 104 bed days (3%). Only 33 (0.9%) bed days were used by patients with mortality risk greater than 90%, 60 (1.8%) by patients with poor long term prognosis, and 16 (0.5%) by those with poor quality of life. Nineteen of 34 patients died; withdrawal of treatment was the mode of death in 15 (79%). CONCLUSIONS: Cost containment initiatives focusing on futility in the paediatric intensive care unit setting are unlikely to be successful as only relatively small amounts of resources were used in providing futile care. Paediatricians are recognising futility early and may have taken ethically appropriate measures to limit care that is futile. 2001 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.1136/adc.84.3.265" target="_blank" rel="noreferrer">10.1136/adc.84.3.265</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 2001 Archives of Disease in Childhood Backlog Child Cost Control Critical Illness/classification Death and Euthanasia Empirical Approach Euthanasia Female Goh AY Health Care and Public Health Hospitals Humans ICU Decision Making Infant Intensive Care Units Journal Article London Male Medical Futility Mok Q Passive/statistics & numerical data Patient Admission/statistics & numerical data Pediatric/organization & Administration Preschool Prognosis Prospective Studies Quality Of Life Severity Of Illness Index Teaching Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://doi.org/10.2307/3562922" target="_blank" rel="noreferrer">http://doi.org/10.2307/3562922</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The sorcerer's broom: medicine's rampant technology Publisher An entity responsible for making the resource available The Hastings Center Report Date A point or period of time associated with an event in the lifecycle of the resource 1993 Subject The topic of the resource Humans; Attitude to Health; Attitude of Health Personnel; Social Values; Risk Assessment; Reproducibility of Results; Power (Psychology); Ethics; Uncertainty; Medical; Physicians/psychology; Diffusion of Innovation; Health Care and Public Health; Technology; science; Dehumanization Creator An entity primarily responsible for making the resource Cassell EJ Description An account of the resource Discusses the impact of technology on the practice of medicine. Effect of technology to medical inflation; Influence of technology on the attempt to reform the health care system and on the redirection of the goals of health care system; Problems related to medical technology; Technological solutions to medical problems, Pitfalls of technology as it relates to medical practice. 1993 Identifier An unambiguous reference to the resource within a given context <a href="http://doi.org/10.2307/3562922" target="_blank" rel="noreferrer">10.2307/3562922</a> Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 1993 Attitude Of Health Personnel Attitude To Health Backlog Cassell EJ Dehumanization Diffusion of Innovation Ethics Health Care and Public Health Humans Journal Article Medical Physicians/psychology Power (psychology) Reproducibility of Results Risk Assessment Science Social Values Technology The Hastings Center Report Uncertainty Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Citation List Month Backlog URL Address <a href="http://search.ebscohost.com/login.aspx?direct=true&amp;db=mnh&amp;AN=1524334&amp;site=ehost-live&amp;scope=site" target="_blank" rel="noreferrer">http://search.ebscohost.com/login.aspx?direct=true&amp;db=mnh&amp;AN=1524334&amp;site=ehost-live&amp;scope=site</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Effects of offering advance directives on medical treatments and costs Publisher An entity responsible for making the resource available Annals Of Internal Medicine Date A point or period of time associated with an event in the lifecycle of the resource 1992 Subject The topic of the resource Humans; Personal Autonomy; Withholding Treatment; Prospective Studies; California; Hospitals; Empirical Approach; Professional Patient Relationship; Death and Euthanasia; DNAR Outcomes; Resource Allocation; Health Care and Public Health; Veterans; University; Advance Directives/ec [Economics]; Advance Directives/psychology; California Durable Power of Attorney for Health Care; Control Groups; Cost Control/methods; Life Support Care/utilization; Life Support Care/economics; Patient Satisfaction/statistics & numerical data; Risk Assessment Creator An entity primarily responsible for making the resource Schneiderman LJ; Kronick R; Kaplan RM; Anderson JP; Langer RD Description An account of the resource Objective: To examine the effects of advance directives on medical treatments and on patient satisfaction and well-being and to determine whether the enhancement of patient autonomy through advance directives provides a more ethically feasible approach to cost control than does the imposition of limits through rationing.; Design: Randomized, controlled trial.; Setting: University and Veterans Affairs medical center.; Patients: Two hundred and four patients with life-threatening illnesses, 100 of whom died after enrollment in the study.; Intervention: Patients randomly assigned to the experimental group were offered the California Durable Power of Attorney (a typical proxy-instruction directive), and patients assigned to the control group were not offered the advance directive. Hospital admissions were monitored to assure that a summary of the document was present in the active medical record at each hospitalization.; Measurements: Cognitive function, patient satisfaction, psychological well-being, health locus of control, sense of coherence, health-related quality of life, receipt of medical treatments, and medical treatment charges.; Results: No significant differences were found between advance-directive and control groups regarding psychosocial variables, health outcome variables, and medical treatments or charges. Patients offered an advance directive had an average hospital stay of 40.8 days (95% CI, 32.2 to 49.4 days), compared with an average of 33.1 days (95% CI, 26.0 to 40.2 days) for controls. Patients offered an advance directive were charged an average of $19,502 (95% CI, $13,030 to $25,974) for medical treatments in the last month of life compared with $19,700 (95% CI, $13,704 to $25,696) for controls.; Conclusions: Despite claims that public demand for longer life accounts for rising medical costs, most surveys suggest that patients are calling for less, not more, of the expensive, high-technology treatment often used in terminal phases of illness. Executing the California Durable Power of Attorney for Health Care and having a summary copy placed in the patient's medical record had no significant positive or negative effect on a patient's well-being, health status, medical treatments, or medical treatment charges.; 1992-10 Rights Information about rights held in and over the resource Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s). Type The nature or genre of the resource Journal Article 1992 Advance Directives/ec [Economics] Advance Directives/psychology Anderson JP Annals Of Internal Medicine Backlog California California Durable Power of Attorney for Health Care Control Groups Cost Control/methods Death and Euthanasia DNAR Outcomes Empirical Approach Health Care and Public Health Hospitals Humans Journal Article Kaplan RM Kronick R Langer RD Life Support Care/economics Life Support Care/utilization Patient Satisfaction/statistics & Numerical Data Personal Autonomy Professional Patient Relationship Prospective Studies Resource Allocation Risk Assessment Schneiderman LJ University Veterans Withholding Treatment