He acknowledged that having a conversation about end-of-life measures such as cardiopulmonary resuscitation, and the consequences of not receiving it, does not come easily to many people.

"I think it's difficult for families because they don't know what might happen" to a loved one in the future, he said.

But waiting to discuss those issues until they actually need to be decided can make things worse.

"I think it's extremely difficult for families, because families are often forced into this position at the worst time," Volandes said. "And I blame doctors."

Volandes doesn't exempt himself from this finger-pointing. Doctors often know the treatment and procedures they are administering to terminally ill patients are ultimately futile, costly and the source of pain and stress.

Dr. David Goodman, a Dartmouth Medical School professor, in 2013 co-authored a study published in the Journal of American Medical Association that found that while there had been an increase in the use of hospice services over the prior decade, there also had been an increase in the use of intensive care units. The study found that while more people were going to hospice, many were going there just for a few days after being in the ICU.

Goodman has cited the case of his colon cancer-stricken sister, who died while undergoing a medical procedure just a day before she was supposed to enter hospice and spend her final days there.

"Poor communication leading to unwanted care is epidemic in many health systems," Goodman said at the time the JAMA report was issued. "The patterns of care observed in this study reflect needlessly painful experiences suffered by many patients, including my sister, and other friends and family members of the research team,"

Early in Volandes' book, he writes about being a young resident and treating a 78-year-old, terminally ill lung cancer patient, a mine worker and immigrant from Ukraine whose condition left him "too confused to have a lucid conversation," and who "lacked family members to guide his decision-making."

"So his medical plan was the default for all patients: Do everything possible to keep him alive," Volandes wrote.

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A conversation everyone needs to have