I WAS standing by my 89-year-old mother’s hospital bed when she asked a doctor, “Is there anything you can do here to give me back the life I had last year, when I wasn’t in pain every minute?” The young medical resident, stunned by the directness of the question, blurted out, “Honestly, ma’am, no.”

And so Irma Broderick Jacoby went home and lived another year, during which she never again entered a hospital or subjected herself to an invasive, expensive medical procedure. The pain of multiple degenerative diseases was eased by prescription drugs, and she died last November after two weeks in a hospice, on terms determined by explicit legal instructions and discussions with her children — no respirators, no artificial feeding, no attempts to buy one more day for a body that would not let her turn over in bed or swallow without agony.

The hospice room and pain-relieving palliative care cost only about $400 a day, while the average hospital stay costs Medicare over $6,000 a day. Although Mom’s main concern was her comfort and dignity, she also took satisfaction in not running up Medicare payments for unwanted treatments and not leaving private medical bills for her children to pay. A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do — and do not — want by writing living wills and appointing health care proxies.

As the aging baby boom generation places unprecedented demands on the health care system, there is little ordinary citizens can do — witness the tortuous arguments in the Supreme Court this week over the constitutionality of the Affordable Care Act — to influence either the cost or the quality of the treatment they receive. However, end-of-life planning is one of the few actions within the power of individuals who wish to help themselves and their society. Too few Americans are shouldering this responsibility.