From the Robert Powell Center for Medical Ethics at the National Right to Life Committee:

Deep Desire To Reduce Health Care Spending Using Advance Care Planning Can Mean Premature Death:

Gundersen Lutheran Health System, a physician-led, not-for-profit integrated delivery system serving more than 550,000 people in Wisconsin, Iowa, and Minnesota, implemented a program promoting advance care planning. According to an analysis done by the Commonwealth Fund, Medicare spends $8,000 less per patients treated at Gundersen Lutheran than the national average—and roughly $10,000 less at Gundersen Lutheran during the last six months of life than at other area hospitals. The analysis specifically attributed these lower costs to the completion of advance directives associated with the health system’s promotion of advance care planning.

How does Gunderson save this money?

A group of national and local disability rights groups had pointed words regarding Gundersen Health Care System Respecting Choices advance care planning documents entitled “Tube Feeding:  What You Should Know” and “Help With Breathing:  What You Should Know.”  In a letter to Bernard Hammes, Ph.D., the Director of Medical Humanities and Respecting Choices, the groups wrote,

However, using frequently identical language, both documents reflect a strong bias against using these medical devices for any purpose other than short-term recovery. The documents describe long-term use of these devices as fraught with discomfort and unpleasant side effects, and actively discourage individuals from even trying them despite the certainty that they will die as a result. ... Many of the undersigned individuals are among the tens of thousands of people with disabilities who use these medical technologies on a long-term basis and are therefore able to enjoy meaningful, productive and fulfilling lives.

The groups asked Gunderson to make specific changes including,