Can the United States Buy Better Advance Care Planning?

Since the early 1980s, the delivery of care near theend of life in the United States has changed dramatically—and improved—often without much no-tice. The rights of persons to refuse all types of medical interventions are well-established and no longer liti-gated. Pain is now the fifth vital sign. Specialized palli-ative care consultative services are available in most U.S. hospitals (1). Increasing numbers of persons in the United States die while receiving hospice care, includ-ing 60 % of those who have died of cancer (2). And new initiatives are increasingly prompting clinicians and pa-tients to engage in advance care planning, such as completing written advance directives. Yet, even with these changes, much has nonethe-less stayed the same. Despite nearly 30 years of effort to get persons in the United States to complete ad-