The US Health and Human Services Secretary has been forced to clarify his proposal to use living wills to slash the soaring cost of end-of-life care. “It would not just save families anguish but would likely save the system a remarkable amount of money,” Mike Leavitt told hospital administrators earlier this month. About one third of Medicare’s US$295 billion budget is spent on care for patients in the last year of their lives.

However, after academics pointed out that this appeared to be false, Mr Leavitt’s staff were forced to play down his comments. The consensus seems to be that while advance directives may give people the power to make decisions, they do not save money. There are several reasons: many people sign documents with conflicting or limited instructions; many do not include a do-not-resuscitate order; some doctors do not follow the directives; and not all directives call for less aggressive and less costly treatment.”

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