I completely believe that the entire medical system is geared toward quantity of life rather than quality of life. Medical professionals rarely have to defend against making decisions that produce a poor life quality, and do have to defend (expensively) against decisions that can be interpreted as shortening someone's life.

This unfortunately can make prioritizing quality over quantity an act of moral courage. And most of us are not known for our moral courage. I fail to see why the average medical professional should be any different from the rest of us in that regard.

In addition, I'm sure it's true that when face to face with a specific situation rather than an abstract circumstances, people change their minds. I'm staring down the eventual barrel of Alzheimer's. Is what I want now going to be different than what I want when I'm past the MCI stage? Beats me.

Until quite recently from a historical and cultural perspective, we all just died of stuff. And choosing when or whether to die was not something most of us had to struggle with, including people in the medical profession. In the meantime, we're stuck at the point when society is figuring this out, it's hard, and the wrong answer happens more than it should.

I like the hospice suggestion. Also having a good personal relationship with your key medical professionals (so they know you as a human rather than a cluster of symptoms), and going on record wherever you can about your preferences.