We decided together that he would want "everything done" unless he were brain damaged, in a coma with little hope of waking up or had metastatic cancer that was resistant to all treatment.
Afterward I asked him how often he would like to have this discussion. "Once in a lifetime is enough," he said. "What would you think if I tried to bring it up every year?" I asked. "I'd think I was about to die," he replied.
Like many physicians, I talk to my patients about how aggressive they want me to be if and when they are dying. But I don't see a role for the government incentivizing this kind of planning session on a regular basis except as a way of advancing their own agenda, which clearly is decreasing end-of-life care.
Financially, one can understand why the government wants to attack this area of care. Last year alone, Medicare paid $55 billion just for doctors' and hospital bills connected to the last two months of patients' lives. If you want to "bend the cost curve," you can't ignore this spending, particularly with the baby boomers aging.
But the practice of medicine is about saving people, not pinching pennies. And in the real world of medical care, "advanced directives" have a limited value when a life-threatening illness actually comes. Dying is almost never as envisioned; people who are sure they would want to give up often wind up being the biggest fighters against death. In the fight against disease, it is morally difficult for both doctors and patients to shut down the machines when there is still hope left.