Advance Directives, Apples and Oranges

We read the article by Chambers et al,¹ entitled "Relationship of Advance Directives to Hospital Charges in a Medicare Population" with interest. The authors compare their results with those in our article, "Effects of Offering Advance Directives on Medical Treatments and Costs."² Chambers et al found medical charges significantly reduced in patients dying in the hospital when there were documented discussions between them and physicians about limiting care. We² and others³ have found no savings associated with the execution of advance directives. Although Chambers et al drew comparisons with our results, unfortunately the similarity in the titles masks considerable dissimilarity in the two studies. We used the term advance directives to signify a written document executed by a person to convey that person's treatment preferences in the event of future loss of decision-making capacity.⁴ Usually, such documents are executed well in advance of the anticipated