Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill after right-wing commentators and Republican politicians denounced it falsely as a step toward euthanasia and “death panels.”

Fifty years ago this November, when Eleanor Roosevelt’s doctor told her that her very debilitating disease was tuberculosis, and potentially curable, he expected her to be thrilled. But she instead uttered “I want to die” three times.

As the Affordable Health Care Act goes into effect, much attention is being paid to end-of-life care, and with good reason. Expenditures during patients’ last year of life are enormous — totaling roughly 25 percent of all Medicare costs – and often not very effective. Yet patients, health care providers and even insurers have a hard time saying no to such interventions.

Mrs. Roosevelt’s case vividly demonstrates how crucial it is for physicians to have frank end-of-life discussions about goals of care with patients and families — something that is still too often avoided. By challenging her physicians on this topic, she was, as usual, ahead of her time.

Mrs. Roosevelt first became ill in April 1960 when she was 75 years old. Doctors diagnosed her with aplastic anemia, a disease in which the bone marrow does not make sufficient red blood cells. Over the next two years, Roosevelt underwent frequent testing as doctors tried to figure out both the cause of her anemia and occasional fevers. Despite her illness, she remained extremely active, traveling to Israel and Europe in February 1962.

But by July 1962, she was much worse. In addition to her anemia, which required frequent blood transfusions, she had daily temperatures as high as 104 degrees. Doctors admitted Mrs. Roosevelt to New York’s Columbia-Presbyterian Medical Center for one week but her symptoms persisted.

Mrs. Roosevelt’s doctors wanted her to be readmitted but she refused. When she finally agreed in late September 1962, she exacted a promise from her primary doctor, David Gurewitsch: When she asked to be discharged, he would consent, regardless of her condition. Dr. Gurewitsch, a rehabilitation specialist, was also a dear personal friend of Mrs. Roosevelt.

The famous patient gamely tolerated three weeks of invasive testing. By this point, her doctors suspected that her longstanding fevers might be due to tuberculosis that had spread throughout the body, known as miliary tuberculosis, and had prescribed pills. But the results were not back.

In mid-October, Mrs. Roosevelt told Dr. Gurewitsch and her children she wanted to go home. “Patient very miserable with temperature rising,” read one nursing note. Although Dr. Gurewitsch planned to honor his promise, several other Columbia physicians remained quite concerned their patient was no better and still lacked a definitive diagnosis.

Dr. Randolph Bailey was more sympathetic. “Everything has been done diagnostically that can be done,” he wrote in her chart. “Mrs. Roosevelt is determined to go home and she has a right to make her own decision.” So on October 18, home she went, driving through her beloved Central Park one last time.

One week later, the diagnosis of tuberculosis — usually a treatable infection — was confirmed. Now Dr. Gurewitsch did a 180, announcing that his patient’s chance for a cure had gone up “5000 percent.”

But when he told Mrs. Roosevelt the news, she reiterated her wish to die. Her children ardently agreed with her.

So Mrs. Roosevelt stayed home. She continued to take pills, but on November 4, 1962, she became comatose. Three days later the “First Lady of the World” was dead.

It turned out that Mrs. Roosevelt’s tuberculosis had been drug-resistant and thus incurable. But it is unlikely that she would have cared. By late 1962, Mrs. Roosevelt had been ill for two-and-one-half years. In one of her final “My Day” newspaper columns, she used the phrase ”articles of torture” to refer to her hospital testing. Even if her tuberculosis had been treatable, she had numerous other medical problems that would have still plagued her. It is unlikely she would ever have returned to the vigorous lifestyle she so enjoyed.

Hospitals remain full of elderly patients as or more ill than Eleanor Roosevelt receiving aggressive and expensive medical interventions ranging from ventilators to hemodialysis to intensive care. Even when they prolong life, they often cannot reverse terminal conditions. The ACA is a wonderful opportunity for us to reassess the true value of medical treatments. Just because someone is admitted to the hospital or has a condition that can be temporarily ameliorated does not mean that we must blindly forge ahead. There is something to be said for dying at home like Eleanor Roosevelt did — unattached to any machines.

When it comes to medical care, many patients and doctors believe more is better.

But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

“What people are not realizing is that sometimes the test poses harm,” said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.”

“Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone.”

Have you experienced too much medicine? As part of The New York Times’s online series The Agenda, I asked readers to share their stories. More than 1,000 responded, with examples big and small.

Some complained that when they switch doctors they are required to undergo duplicate blood work, scans or other tests that their previous doctor had only recently ordered. Others told of being caught in a unending maze of testing and specialists who seem to forget the patient’s original complaint. I heard from doctors and nurses, too — health professionals frustrated by a system that encourages these excesses.

Terrence Power of Breckenridge, Colo., said that after his wife, Diane, learned she had Wegener’s disease, an uncommon autoimmune disorder, the couple found it difficult to refuse testing recommended by a trusted doctor. The doctor insisted on office visits every three weeks, even when she was feeling well. He frequently ordered blood tests and X-rays, and repeatedly referred her to specialists for even minor complaints. Even when tests came back negative, more were ordered, and she was hospitalized as a precaution when she developed a cold. During one six-month period, she had 25 doctor visits. The couple was spending about $30,000 a year out of pocket for her care.

“He was convincing enough that we felt we needed to have it done,” said Ms. Power, 60, who recalls being sedated before an endoscopy procedure, one of the last tests she allowed her doctor to perform. “When they were getting ready to knock me out I was thinking, ‘Why am I doing this?’ But we felt like the doctor knew what to do and we trusted him.”

After several years of physical suffering and near financial ruin from the medical costs, the couple began questioning the treatment after consulting with other patients in online support groups. Mr. Power spoke with his own primary care doctor, who advised him to find a new specialist to oversee Ms. Power’s care. “It’s a really hard thing to determine when they’ve crossed the line,” Mr. Power said. “You think she’s getting the best care in the world, but after a while you start to wonder, what is the objective? He seemed caring, but he didn’t really consider my wife’s time and the suffering she was going through having all these tests done.”

Under the new doctor’s care, the regular testing stopped and Ms. Power was finally able to achieve remission. Now she sees the doctor only four or five times a year.

Sometimes the toll of too much medicine is brief, but emotional. Kara Riehman, 43, of Atlanta was vacationing in California when she lost a struggle with an ironing board in her hotel room and ended up with a black eye.

As the bruising peaked around 10 days, she called her doctor to make sure everything looked normal. But instead of seeing her, the doctor, through a conversation with the nurse, ordered a CT scan. She had no symptoms other than a bruised eye, but the doctor never spoke with her or examined her. The scan came back with an ambiguous finding, and the nurse told her it could be a tumor. She was then given an M.R.I. and for two weeks while she waited for the results, she worried she had brain cancer. The nurse called to tell her the M.R.I. was fine.

“It was really terrible,” she said. “It was only two weeks, but there is a lot of cancer in my family. I never actually talked to my doctor through this whole thing.”

The total cost to her insurance company was about $7,000. “It did change how I think about interacting with the medical system,” Ms. Riehman said. “It made me much more of a questioning consumer.”

Jim Donohue, a Brooklyn bank examiner, had to intervene on behalf of his father, now 79, who had a stroke in March 2007. Doctors in Florida put him on several medications, including two antidepressants, and soon after the man began hallucinating and showing signs of dementia. Mr. Donohue began researching the drugs, and learned they were associated with cognitive problems. He persuaded his father’s doctors to change the medication, and his father quickly improved. He has since recovered, and has been living on his own for four years.

“All the medical professionals seeing him along the way, the hospital, two nursing homes and nobody thought of this,” said Mr. Donohue, who said his father never should have been given a diagnosis of depression in the first place. “I don’t know if we have too many specialists and every one is trying to practice their specialty, but it should not have happened.”

When Kathryn Gullo, a teacher in the Los Angeles area, gave birth to twins just 25 weeks into the pregnancy, she was thrust into the intense medical care of the neonatal ward that saved her children’s lives. But when her daughter, Grace, was 3 months old she was transferred to a different hospital, where the doctors insisted on subjecting her to a battery of tests for symptoms that other doctors had dismissed as normal for her condition. “We felt like we were being bullied,” Ms. Gullo said. “I had enough faith in her previous doctors that it was then easy to say no.”

The family switched hospitals and their daughter, now 5 and living with mild cerebral palsy and some vision and feeding issues, continues to require specialized care. But recently, when doctors suggested an M.R.I. that would require that their daughter be anesthetized, Ms. Gullo and her partner, Katie Ingram, said they asked two key questions: “What new information will this give us?” and “Will it change what we are doing?” After talking to the doctor, they declined the M.R.I.

“Not every mystery has to be solved, and not every problem has to be addressed,” Ms. Gullo said. “That’s hard to get your brain around.”

The hospital delivered those treatments anyway. She spent ten miserable days in the ICU, tethered to machines and tubes and pleading for it all to stop. Finally it did, and Margaret died. Then the hospital billed Medicare for all her unwanted treatment and Medicare paid – without objection, with our taxpayer dollars.

Margaret’s story is far too common. At Compassion & Choices we intend to put teeth into advance directives, and we need your help.

It is well documented that although advance directives are offered and included in the medical chart – as the law requires – in the end they are usually ignored. The pattern is cruel and absurd, and even the medical profession is starting to understand that. Last year the Archives of Internal Medicine reported, “Persons dying in the hospital often receive burdensome care immediately before death that may not match patient preferences.”

Aggressive medical interventions in the setting of terminal illness do not prolong life, but they do increase the suffering of patients and their loved ones. Sadly, Medicare, Medicaid and private insurance carriers incentivize healthcare providers by paying for unnecessary and unwanted treatments.

This could end if public and private health payers required, as a condition of payment, that treatment in the weeks prior to death conform to the patient’s advance directive.

Here is one way you can help. Tell us if you know of a situation where a doctor or hospital disregarded a person’s explicit instructions or the instructions of a surrogate decision-maker. Your stories will help drive that point home with health insurers, hospitals, and health care providers.

As soon as providers realize the costly, unnecessary and painful procedures, tests and treatments they contemplate for a dying patient may be at their own expense, advance directives will acquire unprecedented power and authority. When providers choose treatment based on what patients want, we will have achieved real progress in shielding people near the end of life from the type of suffering Margaret Furlong endured.