Death and dignity - Terminal illness and the market for non-treatment

We construct a stochastic model of illness, death and treatment choice to a nalyze two proposals - legally-binding advance directives and insurer-paid compensation schemes - to reduce the incidence of aggressive and possibly f utile end-of-life treatment. We assess whether, in a competitive insurance market, the proposals are consistent with (i) individual rationality in sel ection of competitive insurance contracts; (ii) medically ethical treatment provision, and (iii) reductions in end-of-life expenditures. We conclude t hat binding advance directives are always medically unethical, while compen sation schemes are medically ethical. We derive the compensation schedule a rising in a competitive equilibrium, and show that it reduces aggressive tr eatment and satisfies individual rationality. (C) 2000 Elsevier Science S.A . All rights reserved.