Re-writing the Final Chapter: The origins of advance directives and end-of-life care in the 1960s

Abstract: The advance directive, first proposed by legal activist and scholar Luis Kutner in 1969, emerged in response to rapid medical advancement in the twentieth century, redefining end-of-life options for terminally ill patients. While novel medical interventions were capable of hastening death, patients lacked clear mechanisms to assert control over their end-of-life decisionmaking. Kutner’s concept of a "living will" sought to address this issue, granting patients a means for communicating their treatment preferences in advance. This presentation examines the historical origins of the advance directive, exploring how technological advancements in medicine coincided with the euthanasia movement in the 1960s and shaped early discussions around patient autonomy. By analyzing the motivations behind the creation of the advance directive, we can better understand how historical concerns about medical authority inform contemporary debates on end-of-life decisionmaking, particularly in relation to ongoing discussions about medical aid in dying in the United States. Using a historical lens, this presentation will analyze how conversations surrounding patient autonomy in the late 20th century can be meaningfully incorporated into modern healthcare discussions.

Keywords: Autonomy, Advance Directives, End-of-life care