Futile care: prevention and process: educating patients about advance directives is crucial.

The current health care reform movement offers unique opportunities to address the issue of futile care. Possible solutions include the widespread use of advance directives, particularly durable power of attorney and cardiopulmonary resuscitation directives; the establishment of regional consortia for developing guidelines for the reasonable termination of care; and the use of patient registries and structured outcome studies to identify patients for whom treatment is likely to be futile. In addition to developing guidelines, regional consortia can serve as monitors for insurers or managed care plans that may attempt to limit care inappropriately.