“Engaging in a discussion about end-of-life issues does not have to be a dark, depressing matter. Many people are willing to spend a Saturday learning CPR, but their time would be better spent drawing up an advance directive.”

This is the conclusion reached by Stephen P. Kiernan, 46, the author of a new book, “Last Rights: Rescuing the End of Life From the Medical System” (St. Martin’s Press). Mr. Kiernan spent three and a half years studying why so many Americans die “bad deaths.”

In a recent interview, he said talks on advance directives — living wills and health care proxies — should be routinely sponsored by religious and civic organizations. And because many people avoid the subject, he said that at the talks, medical and legal professionals should provide the proper forms and guidance on how to complete them.

Mr. Kiernan also suggested that the life insurance industry start working with clients to write living wills and that driver’s licenses include a box stating that the person has such a will and has assigned a health care proxy.

Many people are under the mistaken impression that it is good enough to tell friends and relatives how they wish to be treated in a life-threatening situation. Surveys have shown that few, if any, would want to be kept alive indefinitely if they were in a persistent vegetative state, or resuscitated if they were near death with a terminal illness.

But in practice, unless a patient’s wishes have been put in writing, there is a good chance they will not be followed, Mr. Kiernan’s research showed.

He sees at least three of what he called “imperatives” behind the need for all adults to complete an advance directive that clearly states how they wish to be treated if they are unable to tell doctors what they do or do not want:

1. To prevent avoidable suffering for the patient and the patient’s survivors. An advance directive permits people to take control during the most vulnerable times of their lives and avoid unwanted, futile medical intervention that can cause anguish for loved ones. Research data Mr. Kiernan cited revealed that spouses are twice as likely to die after their partners’ death if end-of-life care was not good.

2. To protect caregivers. “Doctors don’t want to be flying in the dark, but they are so scared of being sued that they overtreat,” Mr. Kiernan said. An advance directive protects doctors against litigious relatives, who may threaten doctors with lawsuits if they fail to start — or decide to discontinue — life support, even when there is no chance for the patient to recover.

3. To avoid bringing financial ruin to patients’ families. “Health care expenses are now the leading cause of bankruptcy, even among people who have health insurance,” Mr. Kiernan said. “If everyone had an advance directive, it would save $1.7 billion a year in health care expenses.”

“Too often, medical care is confused with love,” he continued. “They’re not the same. Sometimes the best thing you can do for someone you love is to stop the medical care.”

The Web site www.caringinfo.org provides state-specific instructions for completing advance directives through Caring Connections, a program of the National Hospice and Palliative Care Organization, which is sponsored by the Robert Wood Johnson Foundation and monitors changes in state laws.

There is a further need, Mr. Kiernan added, for Americans to demand that hospitals provide palliative care — adequate treatment of pain and other debilitating symptoms commonly experienced by people near death. “As long as Americans continue to have horrific end-of-life experiences, they will continue to advocate for physician-assisted suicide,” he said. “If suffering is not adequately treated, they’ll choose to die.”

Physicians who specialize in palliative care, however, report that when the fear of pain and suffering are removed, the demand for euthanasia all but disappears.

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