Advance Directive and USA 预设医疗指示在美国

According to Wikipedia, advance directives were created in response to the increasing sophistication and prevalence of medical technology. Of U.S. deaths, 25–55% occur in health care facilities. Numerous studies have documented critical deficits in the medical care of the dying; it has been found to be unnecessarily prolonged, painful, expensive, and emotionally burdensome to both patients and their families.

Aggressive medical intervention leaves nearly two million Americans confined to nursing homes, and over 1.4 million Americans remain so medically frail as to survive only through the use of feeding tubes. As many as 30,000 persons are kept alive in comatose and permanently vegetative states.

Cost burdens to individuals and families are considerable. A national study found that: “In 20% of cases, a family member had to quit work;” 31% lost “all or most savings” (even though 96% had insurance); and “20% reported loss of [their] major source of income.” Yet, studies indicate that 70-95% of people would rather refuse aggressive medical treatment than have their lives medically prolonged in incompetent or other poor prognosis states.

Living wills proved to be very popular, and by 2007, 41% of Americans had completed a living will. On July 28, 2009, Barack Obama became the first United States President to announce publicly that he had a living will, and to encourage others to do the same.

根据维基百科，预设医疗指示是为了应对日益复杂和普及的医疗技术。在美国的死亡人数中，25-55％发生在医疗机构。许多研究记录了垂死病人医疗护理中的关键缺陷是会不必要地延长治疗, 对患者及其家属造成痛苦，并且昂贵和引起情绪上沉重的负担。

激进的医疗干预使得将近二百万美国人坐困于养老院，超过一百四十万美国人身体虚弱得只能通过使用饲管生存。多达3万人只能保持昏迷和成为永久植物人。

个人和家庭的成本负担相当可观。一项国家研究发现：“在20％的个案中，一名家庭成员不得不辞掉工作”;31％失去了“全部或大部分储蓄”（尽管有96％有保险）; “20％的人报告说他们损失了主要收入的来源”。然而，研究表明，70-95％的人宁愿拒绝进行激进的医疗治疗，而不选择在无能或其他不良预后状态下用医疗技术延长生命。

生前遗嘱被证明是非常受欢迎的，到2007年，有41％的美国人已经完成了生前遗嘱。 2009年7月28日，巴拉克·奥巴马成为美国第一任公开宣布他有生前遗嘱的总统，并鼓励其他国人做同样的事情。