Emanuel knew at least as early as 1988 that Advanced Directives and how they really give power to the doctors to make end of life happen sooner. The following is a 2003 article:

Gregory W. Rutecki, M.D.
rutecki_an_evangelical_critique_of_advance_directives.php

Emanuel 29 followed nursing home patients for two years after the completion of an advance directive. After medical record review and physician interview, the authors concluded that in many cases the patient’s choices were overridden because their physician disagreed with the wisdom of their choice. On occasion, the override represented the withholding of treatment because the physician decided it would not benefit the patient. End-of-life choices through vaguely worded advance directives may be primarily relegated to physicians who lack a consensus about what it means to be human”. “With increasing governmental and third party intrusion into the contemporary contract model of medical care, will advance directives become a coercive tool that rations end-of-life care by offering euthanasia as a cheaper alternative to life?”
29. op. cit., Emanuel, E.J., et al., 1988.