Seven in ten Americans over age 60 who require medical decisions in the final days of life lack capacity to make them. For many of us, the biggest life-and-death decisions of our lives—literally—will, therefore, be made by someone else. They will decide whether we live, die, or experience a fate worse than death; between long life and quality of life; the level of risk or suffering to assume in the hope of a cure; whether we receive comfort care or heroic interventions in our last hours; and whether we die at home or in a hospital. They will determine whether our wishes are honored, forgotten, or betrayed and choose between fidelity to our interests and what is best for themselves or others. They will also control many of the expenditures on health care near the end of life, much of it, studies find, for unwanted treatment. Yet despite their critical role, we know remarkably little about how they will decide for us.
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