Advance patient directives: are they worth it?

The Patient Self-Determination Act became effective in December 1991. After two complete years of experience, data are emerging to indicate how implementation of the Act has affected the issues of patient autonomy and cost containment. In this third article of a series on advance directives, the authors conclude that the preliminary results of their study are consistent with other studies recently completed that demonstrate the favorable effect of the Act on enhancing patient autonomy and containing the costs of health care. The authors suggest a basic study design for replication and adaptation by others, encourage more uniformity by researchers in future studies to more precisely measure the effect of the Act, and briefly describe the expansion of their continuing study.