Why have this discussion?

In my career as a pulmonary and critical care physician, I often found people who, as death closed in, had never had meaningful conversations with their loved ones about their wishes. This often caused confusion in families and medical providers as they struggled to decide how much medical intervention the patient really wanted. Even in this era of advanced directives, my patients would often say, "my kids will know what to do" but they'd never really had a meaningful discussion with them. In the ICU, the medical default is to intervene with life prolonging interventions such as CPR and ventilators, basically to shock the heart and to support breathing. But would the 94 year old dying from lung cancer really want these things? And how do we become educated and make choices?

I hope to engage you and others in this discussion which brings in ethical, cultural, religious, and basic life views. All thoughts are welcome.