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This article examines the social welfare policies of the US criminal justice system and how they have contributed to mass incarceration.

Traci Burch argues that the criminal justice system has a disproportionate impact on marginalized communities, having a negative impact on political engagement.

This article explores the ethical and practical challenges faced by agents who make life-and-death medical decisions on behalf of their principles.

This article, featuring Reuben J. Miller, follows the journey of African American boys in a Chicago charter school as they navigate community violence.

This article explores the contradictions of criminal justice reform efforts in the United States, suggesting that the political and economic interests that support the current criminal justice system make it difficult to achieve more transformative reforms.

This article documents the prevalence in organized interest politics in the United States of organizations that have no members in the ordinary sense and analyzes the consequences of that dominance for the democratic representation of citizen interests.

In this article, Shapiro explores efforts to compensate health professionals for advanced care planning amidst contemporaneous changes to Medicare and Medicaid beginning in 2016.

This article, featuring Reuben J. Miller, examines the institutional and policy arrangements of prisoner reentry.

Susan Shapiro examines the effectiveness of advance directives in directing end-of-life care, exploring the limitations of these legal documents in this article.

  • Articles

Do Advance Directives Direct?

Susan P. Shapiro
Making and Implementing Law
June 2015

From the Duke University Journal of Health Politics, Policy and Law:

Resolution of long-standing debates about the role and impact of advance directives—living wills and powers of attorney for health care—has been hampered by a dearth of appropriate data, in particular data that compare the process and outcomes of end-of-life decision making on behalf of patients with and without advance directives. Drawing on a large ethnographic study of patients in two intensive care units in a large urban teaching hospital, this article compares aspects of the medical decision-making process and outcomes by advance-directive status. Controlling for demographic characteristics and severity of illness, the study finds few significant differences between patients without advance directives and those who claim to have them. Surprisingly, these few differences hold only for those whose directives are in their hospital chart. There are no significant differences between those with no directive and those claiming to have a copy at home or elsewhere. The article considers the implications if directives seemingly must be in hand to show even modest effects. Do advance directives direct? The intensive care unit data provide far more support for the growing body of literature that casts doubt on their impact than studies that promote the use of them.