Los Angeles Times:  “I could show you case after case,” said Dr. Neil S. Wenger. “I could bet you million-to-1 odds these patients would not want to be in this situation.”

He was talking about patients in critical condition who are “attached to machines, being kept alive” in hospitals, many of them suffering.

A common reason for that, said Wenger, director of UCLA's Health System Ethics Center, is that fewer than one-third of us make our healthcare wishes known in advance of critical illness or injury. So if we end up comatose after an accident, or with severe memory loss in old age, we're kept alive, regardless of the cost and regardless of what our wishes might be or how grim the prognosis.

It's understandable. Nobody wants to think in advance about life ending. In our satisfied state of denial, we want to believe medical advances will keep us healthy until we die in our sleep at a ripe old age. But death doesn't always come on our terms, and failing to face up to other possibilities can put crushing burdens on loved ones — not to mention that soaring end-of-life medical costs are at the center of the national budget crisis.

“We use healthcare resources far out of proportion to any other country on the planet,” said Wenger, who researches elder care for the Rand Corp. “We need to have a conversation about where society wants to put its resources

[and we] might decide there are certain kinds of life extension that are not as important to us as educating kids and having adequate infrastructure.”

Of course, none of us individually can solve all of these societal issues. But there are things we can do to make our own situations better at the end of life. It's never easy to think about your own demise, or the demise of those you love, or to start uncomfortable but necessary conversations about death. But since my father's health began to deteriorate this summer, I've talked to many medical people who say we need to get over our fears. Today, I'm passing along their advice. Consider it your guide to the final frontier.

One of the first decisions to make — in advance of any crisis — is whom you want making healthcare decisions if you're unable to do so on your own because of illness or injury. And that has to be done in writing.

Judy Citko, executive director of the Coalition for Compassionate Care of California, advises completing what's known as an Advance Healthcare Directive. An easy way to learn more about this is to visit her nonprofit agency's website, http://www.coalitionccc.org, which is loaded with good information on planning. And no matter what state you live in, you can get an Advance Healthcare Directive by going to Caring Connections at http://www.caringinfo.org.

The California form, which doubles as a living will, is free and can be printed from the website. On it, you can authorize a loved one or someone else to have power of attorney — or serve as your agent — to make healthcare decisions for you if you're unable. You can indicate whether you want your life “to be prolonged as long as possible” or, alternatively, that you don't want your life “to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits.”

Continue reading about healthcare directives.