Slate has a piece on palliative care in the ER. The problem of overtreatment has at least two prongs. The first leans toward dry policy discussions: the fee for service system may simply be the worst system except for all the others. The second, however, is a very wet kind of problem. Decisions about when to end treatment are rarely clear or easy. There is the old policy chestnut that 90% of healthcare is spent on the last 10% of life (can anyone verify that, by the way)?
Understanding how that can happen is easy. Emergencies requiring minute-to-minute decisions are not the time to make long term decisions; when your mother's heart stops beating is not the time to ponder the nature of eudaimonia. So the emergency room makes poor soil for the roots of such discussion. The place and time is before the emergency; in one's home, in the church, or, ideally, in the primary care doctor's office.
('The primary care doctor's office?' you say. 'Who even has one of those?' Exactly).
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