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When quality of life is undefined, medical care defaults to aggressive interventions.

Early goals-of-care conversations reduce family anxiety and decisional regret.

Surrogate decision-makers face higher stress when wishes aren't discussed in advance.

Defining care preferences early aligns treatment and reduces unnecessary suffering.

As a young oncology nurse, I cared for a woman in her late 80s whose cancer had overtaken her body.

She was scheduled for exploratory abdominal surgery.

When I entered her room to perform my assessment, I couldn't even find a place to place my stethoscope. Tumors were visibly protruding across her abdomen. Her disease was advanced beyond medical intervention.

Her family sat nearby, nervous and hopeful. I'm not a doctor, but even I knew that this surgery would be futile. The surgeon proceeded.

He opened her up-and closed her back up.

There was nothing medically that could be done.

I remember standing there asking myself: Why did this happen?

It wasn't because her family didn't love her.

It wasn't because the physician lacked skill.

It wasn't because anyone was indifferent.

It happened because this beautiful, sweet woman had not clearly defined what quality of life meant to her.

When quality of life is undefined, medicine defaults to intervention.

The Default Toward "Doing More"

Modern medicine is structured to treat, extend, and attempt to........

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