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Living wills are not only of legal and bioethical interest; they may also foster the costs of the health care system in the event that they exclude a refusal of end-of-life-treatment. Whereas in Germany and Italy the economic aspects of living wills have been widely neglected so far, in the US there exists a huge body of controversial literature. However, cost arguments in favor of the legal institution of living wills are not corroborated by empirical findings. In contrast, as health economic research shows, an effective living will enhances the utility of the individual, his family, and even the society by underpinning the right of self-determination. In comparison of the three countries, it was shown that the valuation of this right is open to cultural and religious arguments. This study recommends accounting for the necessity of the correct drafting of an individual living will. There are several alternatives to deal with the resulting problems, which are handled differently in Germany, Italy, and the US.
Oehlrich, M. (2013). End-of-life care and the economics of living wills. In S. Negri & J. Taupitz (Hrsg.), Advance Care Decision Making in Germany and Italy: A Comparative, European and International Law Perspective (S. 235–256). Springer.