Nearing the end of your life? Make your wishes clear

Surveys show that most patients nearing the end of their life do not want aggressive medical treatments, such as a respirator or feeding tube. Patients can make those wishes clear to doctors and family members in something called an "advance directive."

Penny Couphos used an advance directive to carry out the wishes of her husband, Louis Couphos. He survived a Nazi concentration camp where he witnessed suffering firsthand and didn't want to linger after being diagnosed with bladder cancer.

"What was important to me was that his wishes be respected,” she said.

Penny Couphos now counsels others on preparing advance directives, such as living wills or a health care power of attorney.

"People who want or feel more comfortable with less-aggressive care at the end of life, their advance directives in regions of the country where care is more aggressive seem to have a bigger impact on care,” said Dr. Kenneth Langa, with the University of Michigan.

Research on the use of advance directives shows that patients who had them ended up with a slightly lower cost of care. The study appears in the Journal of the American Medical Association.

Penny Couphos says she remains passionate about advance directives.

"We have this one life, and only the person who is dying has the right to decide how to end it,” she said. “I tell people, ‘This is your decision, your life.’”

Researchers say only a minority of patients in the decade-long study had an advance directive and about 70 percent were hospitalized during the last six months of life.