Often called living wills, advance health care directives are the best insurance people have against the kind of medically and morally difficult situations that fuel the euthanasia debate. Rather than leave doctors and family to battle with doubt and conflicting emotions, an advance health care directive sets up a sensible framework for making decisions when patients can no longer express their wishes.

“Advance care directives are an extension of our own will,” said Miller at the lecture held at Toronto’s University of St. Michael’s College.

Writing a document that will dictate to doctors what to do in every possible circumstance is a fool’s errand and won’t cut it legally in Ontario or many other jurisdictions, Miller said. However, deciding who will make decisions for you — the substitute decision maker — is the most important question people can settle before they face the inevitable but unpredictable end.

“We all know we’re going to die. We don’t know when,” Miller pointed out. “We can do some planning for end of life.”

What stands in the way is a culture that isn’t very good at talking about death.

“Denial of death is very profound in our society,” he said.

Everyone fears death, but in a society that values individual freedom and autonomy above all else people also fear losing their ability to make their own decisions.

“What I’m really afraid of is I’m afraid of being worthless,” said Miller.

People who demand an early end to life rarely face uncontrollable pain. They generally fear becoming a burden to others, losing control or being abandoned. Palliative care, currently only available to about a third of all Canadians, can address those fears, said Miller.

Assigning a substitute decision maker is the most important part of an advance care directive. If the spouse, child or friend accepts the responsibility and knows your mind it will avoid family conflicts and anxiety and set clear rules for the medical team.