Factors Affecting the Innovation of Advance Directive Law
Unlike MFP, there is a wealth of research about ADL from many perspectives and with
many methods. Scholars have not only studied the innovation of ADL in-depth through case
studies, they have studied the diffusion of ADL across all 50 states. Researchers have thoroughly
examined the impetus for ADL, questioning the role that federal law and landmark court cases at
the state and federal level (like Quinlan and Cruzan) may have played in promoting state law
adoption (Glick, 1992b; Glick & Hays, 1991; Hoefler, 1994). In addition to detailed case studies
about the adoption process in sampled states, there is an event-history analysis and other
quantitative methods employed about what aspects of the state itself might affect adoption
(Glick, 1992a; Glick & Hays, 1991). And although there is one prevailing type of ADL, scholars
have also examined policy reinvention, the minor amendments at each state level that allowed
for the rapid diffusion of ADL across the United States (Glick & Hays, 1991; Hays, 1996).
In the study of not just ADL, but public policy in general, theories note that policies do
not spontaneously manifest without some sort of stimulus (Sabatier, 2007). Typically, the
proverb is "necessity is the mother of invention" and states become alerted to problems and
adopt policies to address those problems (Hays, 1996). The need for ADL is clearly
documented, and also highlighted by contentious landmark court cases. While events like court
battles often alert states to the need for policy, it takes individuals to initiate these changes-
individuals who identify the problem, craft policy solutions and build coalitions. These
individuals are known as policy entrepreneurs, and case studies on the innovation of ADL assert
that these actors played a critical role in the innovation of the first laws regarding medical
disputes (Glick, 1992a).

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