There is a huge gap of understanding between what physicians know is "futile" including the success rate of resuscitation and the general publics perception of it. The main two issues I see are: 1. The general public believes resuscitation is far more effective than it actually is. Survival rates are about 10% for out of hospital cardiac arrest and only 20% for in hospital cardiac arrest. But a much a better endpoint is higher brain function and quality of life which is even lower. 2. When someone is given power of attorney and able to make medical decisions for a loved one, there isn't quite enough communication of what this role entails. Most family members see denying resuscitation or intubation as them "killing" their family member, and as such most are obviously reluctant to do so. It's difficult to separate that feeling with the real responsibility which is to act as a stand in for that person and honor their wishes. Ask would they want to continue to live like this, based off everything you know of them? The results are quite different. The US provides far too much extraordinary care at the end of life, not because it's useful but rather because it's available and physicians aren't equipped for the palliative care discussion that needs to happen. Now why this is the case and how it impacts healthcare costs is another discussion entirely.