Emanuel said that legalizing euthanasia, as was done in the Netherlands, might be counterproductive, in that it would decrease support for pain management and mental health care. However, Emanuel does support the use of Medical Directives to allow patients to express their wishes when they can no longer communicate. Ezekiel, and his former wife Linda Emanuel, an M.D. Ph.D. bioethicist and geriatrician, created the Medical Directive, which is described as more specific and extensive than previous living wills and is a third generation Advance Directive. He claims the Hippocratic Oath debunks the theory that opposition to euthanasia is modern. Emanuel said that for the vast majority of dying patients, "legalizing euthanasia or physician-assisted suicide would be of no benefit. To the contrary, it would be a way of avoiding the complex and arduous efforts required of doctors and other health-care providers to ensure that dying patients receive humane, dignified care." Emanuel said that a historical review of opinions on euthanasia from ancient Greece to now "suggests an association between interest in legalizing euthanasia and moments when Social Darwinism and raw individualism, free markets and wealth accumulation, and limited government are celebrated."