For more than a decade, health policy analysts have noted — and some have decried — the high cost of dying1–7. With the acceleration of pressures on health care costs and calls for reform, considerably more attention has been focused on proposals to control costs at the end of life8. One proposal would require persons enrolling in a health care plan to complete an advance directive9,10. Others would require hospitals to establish guidelines to identify and reduce futile care11–13. Similar ideas have been expressed by members of President Bill Clinton's Health Care Task.
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