Motivation and Emotion, Vol. 29, No. 4, December 2005 ( C  2005) DOI: 10.1007/s11031-006-9017-x Imagining the End of Life: On the Psychology of Advance Medical Decision Making 1 Peter H. Ditto, 2,5 Nikki A. Hawkins, 2,3 and David A. Pizarro 2,4 Published online: 20 July 2006 Near the end of life, individuals often become too ill to express their wishes about the use of life-sustaining medical treatment. Instructional advance directives (i.e., livings wills) are widely advocated as a solution to this problem based on the assumption that healthy people can predict the types of medical treatment they will want to receive if they become seriously ill. In this paper, we review a large body of research from the psychological and medical literatures that challenges this assumption. This research demonstrates that across a wide variety of decision contexts people show limited ability to predict their affective and behavioral reactions to future situations. We outline several ways that policy and law regarding the use of advance directives could be informed by this research, and suggest a number of issues involved in advance medical decision making that could benefit from additional empirical and conceptual attention. KEY WORDS: advance directives; medical decision making; predictive accuracy; affective forecasting. In the spring of 2005, the decision about whether or not to discontinue life- sustaining treatment for a young Florida woman named Terri Schiavo became the focus of worldwide media attention. Characteristically, the energy that politi- cians, interest groups, and the major news organizations directed toward this event was intense, but late in coming and relatively short-lived. In contrast, the deci- sion process faced by Terri Schiavo’s family had been agonizingly long, drawn 1 Dr. Pizarro’s work on the paper was conducted while he was a postdoctoral fellow supported by National Institute of Mental Health, National Research Service Award 5 T32 MH19958. 2 Department of Psychology and Social Behavior, University of California, California. 3 Present address: Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. 4 Present address: Department of Psychology, Cornell University, Ithaca, New York. 5 Address all correspondence to Peter H. Ditto, Department of Psychology and Social Behavior, Uni- versity of California, 3340 Social Ecology II, Irvine, CA 92697-7085, USA; e-mail: phditto@uci.edu. 481 0146-7239/05/1200-0481/1 C  2005 Springer Science+Business Media, Inc.