Enlighten me.
I cannot see how, if the document is clear and unambiguous, its not in every partys (the patient, the family, the practitioners, the insurer) best interest to have documented directives.
The only interests that matter are the interests of the person who executes the document.
Those interests change over time.
The way we perceive medical care when we are healthy is very, very different than the way we perceive it when we are sick.