“We could make tremendous gains if we communicated better with patients and did what they want,” said Frank Ingari, president of Essence Healthcare Inc., an insurer based in Maryland Heights. “It’s not just the money, it’s the suffering. Sometimes life extension is no favor to whom it’s extended.”

Under federal law, hospitals have the duty to ask patients whether they have a living will prescribing their medical wishes, and if not, whether they need assistance in preparing one. But even when patients have such wills — and they often don’t — the documents can be vague, and they’re often ignored by hospitals. They may not even be made available to doctors. And family members, often in panic, can demand more treatment, overriding the will.

Just as doctors may defer to relatives demanding more care, overwhelmed relatives often defer to health care professionals.

“They would tell us, ‘We’ve got to do this, we’ve got to do that.’ They justified everything they did,” Ransburg said. “So we didn’t have much choice but to go along with it.”