Well, it's not that people don't know that someone is terminal, it's that there's still a lot of permission and encouragement to throw every possible treatment at someone. I know that families are understandably upset, but I know of plenty of surgeries and end-stage invasive treatments that have left family members -- who demanded the treatments, by the way -- with the idea that maybe they should have concentrated on quality of life and allowing death with a little dignity.

I think, frankly, that a lot of people have been taught to feel guilty or callous if they don't do everything possible to try and save someone's live, even if it's not possible. Of course, no one wants to seem callous, and it's easy for relatives to get to arguing about what, if anything, to do.

I think there have been a number of studies showing that a great deal of our health care costs are spent near the end of people's lives and don't result in much more than a few weeks' extra time. I think it's natural to fear letting go, but it just makes sense for all of us to issue directives ahead of time -- if we can, of course.