Maybe the fragile patients hovering near death didn't want to go to the hospital for the 10th time, have that final dialysis treatment or live their lives without an iota of privacy. Some families are so reluctant to discuss end-of-life issues that loved ones pass away without having the opportunity to express their last wishes. [...] physicians often are equally hesitant to discuss the inevitable, said Dr. Sarah Selleck, an assistant professor of medicine at Baylor College of Medicine and a specialist in geriatrics. Selleck said she started tackling the subject head on years ago, after she heard a visiting lecturer talk about the art and science of medicine. To help families talk plainly about end-of-life needs, wants and wishes, Selleck, John Mastrojohn, executive vice-president of the National Hospice and Palliative Care Organization, and Dr. Eduardo Bruera, chair of the palliative care and rehabilitation department at the University of Texas MD Anderson Cancer Center, offer these points to consider: 2 You're not too young to appoint a loved one - a partner, an adult child, a trusted friend, a member of the clergy - to make your end-of-life decisions when and if you are unable to make them yourself. When we normalize that, Bruera said, and realize that we all need to make some preparations and plans, it lifts a weight from the shoulders of patients and families.