Who should make the decisions about how much “care” is needed? Should it be government? Insurance companies? Hospitals? Doctors and nurses? Ethics committees? Religious institutions? My perspective is that the values that should be applied are the patient’s. I want to provide honest and accurate information, and then let the patient make the decision. But if patients haven’t expressed their wishes or designated someone who can act for them if they’re incapacitated, controversy and family upheaval often ensue.

By facing the realities of death and dying, we can make the choices that will allow us and our loved ones to find the “best of both worlds,” where life is prolonged and its inevitable end is as comfortable, conscious, and supported as possible.

Advance directives are not just for old people. The three most famous cases in American legal history concerned women under age 30 (Nancy Cruzan, Karen Quinlan, and Terry Schiavo). Every adult should complete an advance directive and update it as life’s circumstances change.

Let’s make it the mission of emergency medicine to complete our own advance directives, and let’s ask our friends, families, and patients to do the same. If advance directives were to become the norm – if say, 80% of Americans had them – we’d be offering more personalized and humane care for far less money. Respecting individual rights is the right way to reduce health care costs.

Dr. Morhaim, FACEP, is a practicing physician, House Deputy Majority Leader in the Maryland State Legislature, faculty at the Johns Hopkins Bloomberg School of Public Health, and 2011 recipient of the AMA’s Nathan Davis Award for Public Service. His book “The Better End: Surviving (and Dying) on Your Own Terms in Today’s Modern Medical World” was recently published by Johns Hopkins University Press (www.thebetterend.com).