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Brief Communication: The Relationship between Having a Living Will and Dying in Place

Howard B. Degenholtz, PhD; YongJoo Rhee, MPH, PhD; and Robert M. Arnold, MD
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From the Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, Pennsylvania.

Preliminary results were presented at the 53rd Annual Scientific Meeting of the Gerontological Society of America, Chicago, Illinois, 14–18 November 2001.

Grant Support: By the National Institute on Aging (grant 1R0 3AG18811-01, “Advance Directives Among the Oldest Old,” Howard B. Degenholtz, principal investigator). Dr. Arnold was supported by the Project on Death in America Faculty Scholars Program, Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, International Union Against Cancer Yumagiwa-Yoshida Memorial International Cancer Study Grant Fellowship, and LAS Trust Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Howard B. Degenholtz, PhD, Center for Bioethics and Health Law, University of Pittsburgh, 3708 Fifth Avenue, Suite 300, Pittsburgh, PA 15213; e-mail, degen@pitt.edu.

Current Author Addresses: Drs. Degenholtz: Center for Bioethics and Health Law, University of Pittsburgh, 3708 5th Avenue, Suite 300, Pittsburgh, PA 15213.

Dr. Arnold: Montefiore University Hospital, 9 South, 3459 Fifth Avenue, Pittsburgh, PA 15213.

Dr. Rhee: Glennan Center for Geriatrics and Gerontology, Eastern Virginia Medical School, Hofheimer Hall, Suite 201, 825 Fairfax Avenue, Norfolk, VA 23507-1912.

Author Contributions: Conception and design: H.B. Degenholtz, Y. Rhee.

Analysis and interpretation of the data: H.B. Degenholtz, Y. Rhee, R.M. Arnold.

Drafting of the article: H.B. Degenholtz, Y. Rhee, R.M. Arnold.

Critical revision of the article for important intellectual content: H.B. Degenholtz, R.M. Arnold.

Final approval of the article: H.B. Degenholtz.

Statistical expertise: H.B. Degenholtz, Y. Rhee.

Obtaining of funding: H.B. Degenholtz.

Administrative, technical, or logistic support: Y. Rhee.

Collection and assembly of data: Y. Rhee.

Ann Intern Med. 2004;141(2):113-117. doi:10.7326/0003-4819-141-2-200407200-00009
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The most common setting for death was the hospital (47%), followed by home (29%), nursing home (18%), hospice (3%), and other (3%). Living wills were completed by 40% of the sample (Table 1). Nursing home residents were more likely to have living wills than people living at home (47% vs. 32%; P = 0.0014). In most cases, living wills expressed a desire to limit medical treatments in certain situations (95%), withhold certain treatments (83%), and keep the person comfortable and pain-free and forgo extensive measures to prolong life (91%). Compared with those without living wills, decedents with living wills were less likely to have received all life-sustaining medical treatments (5% vs. 30%; P < 0.001), more likely to have had treatments withheld (65% vs. 29%; P < 0.001), and more likely to have had efforts made to keep them comfortable and pain-free (94% vs. 86%; P = 0.0051). Most proxy informants indicated that the written instructions applied to the actual situation (86%) and that the forms were consulted (70%). About 81% of living wills were written 2 years or more before death, and 84% of nursing home residents' living wills were completed before relocation.

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Summary for Patients

Do Living Wills Affect the Setting Where People Die in the United States?

The summary below is from the full report titled “Brief Communication: The Relationship between Having a Living Will and Dying in Place.” It is in the 20 July 2004 issue of Annals of Internal Medicine (volume 141, pages 113-117). The authors are H.B. Degenholtz, Y. Rhee, and R.M. Arnold.


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