"As an ER doctor, I am already faced with patients who arrive too sick to tell me their wishes, with no documentation of what those were when they were well enough to articulate them..."

"... and with family members who never asked and, as a result, just don’t know. It is in these situations, as I place tubes and lines in this failing body, that I worry we are not providing care that is concordant with their goals. If I had known that the 68-year-old with recently diagnosed metastatic breast cancer is more worried about being uncomfortable at the end of her life, rather than prolonging it, we wouldn’t have placed that breathing tube and would instead have focused our intensive efforts on making her comfortable. If I had known that the 81-year-old had always hoped to die at home, I would have spent more time trying to mobilize our home hospice team rather than defaulting to a hospital admission.... I recently had this conversation with my own father and found out that he worried more about getting overly aggressive care than he did about not getting enough.... I wish we didn’t have to make and share these difficult decisions, but I worry that we are in a situation that necessitates it even more than usual."

From "Do your loved ones a favor. Find out now how they want to die. I’m an ER doctor, and we need to know what matters most to your family member" by Emily Aaronson (in WaPo).

One thing that Aaronson doesn't talk about is how bad it is in a time of shortage to use hospital equipment and services on people who would prefer to be left at home and to struggle to breathe or die without the invasion of ventilator tubes.

Perhaps the inference is so obvious it's just brutal to specify it. That's a little ironic in an article about the problem of failing to "articulate" things. But I can see why Dr. Aaronson keeps quiet about anything that feels like utilitarianism.