In a culture in which speaking about death and dying has long been taboo, and with a health care system that does not foster such conversations, it should come as no surprise that only about 30 percent of Americans have advance directives for health care on file. Even then, an advance directive is just a paper form, and often one that is not accessible at the point of care.
More meaningful planning occurs when an individual has a health care agent (i.e., a person with the legal authority to make health care decisions on another’s behalf). An effective person serving in this role must not only know and understand another’s wishes for care but also be willing and able to honor them.
The consequences of forgoing this kind of planning are severe. The default in American medicine is “to do everything,” which lends itself to aggressive care and intensive-care unit stays that can be painful for patients and their loved ones and harmful for the health care system as a whole.