Physicians should discuss end-of-life issues, such as living wills and artificial nutrition, with terminally ill patients, U.S. medical professionals say. Monday was National Healthcare Decisions Day -- designed by U.S. medical groups to inspire, educate and empower the public about facing end-of-life care. Observed on April 16 -- normally the day after U.S. income tax returns are normally due -- the event combines both elements of the adage, "Nothing is certain but death and taxes." The U.S. Agency for Healthcare Research and Quality found in 2003 that fewer than 50 percent of the severely or terminally ill had an advance directive in their medical record. An advance health care directive -- also known as living will, personal directive, advance directive or advance decision -- provides instruction by people on what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity, and appoints a person to make such decisions on their behalf if necessary. Nathan Kottkamp, founder and chairman of National Healthcare Decisions Day, said Pew Research found in 2006 84 percent of the public approved of laws allowing terminally ill patients to make decisions about whether to be kept alive through medical treatment -- but only 30 percent had a living will. Dr. David Casarett, Dr. Jennifer Kapo and Arthur Caplan wrote in the New England Journal of Medicine that patients and families are often not fully informed of the relevant risks and potential benefits of artificial nutrition and hydration. Financial incentives and regulatory concerns promote the use of artificial nutrition and hydration in a manner that may be inconsistent with medical evidence and with the preferences of patients and the family, the researchers said.