We all make life-changing decisions as we advance through the decades to old age.

The decisions of where to work, whom (or whether) to marry, how to invest our earnings, where to live, and so on, are almost endless and often dictate the course of our lives.

As with the Robert Frost poem, “The Road Not Taken,” many of us wonder how our lives would have played out if we had chosen a different path.

At no time are our choices more critical than at the end of our lives. More than life-changing, these decisions actually can be life ending.

I thought about this when I got a note from the son of a woman in Texas with whom I exchanged Christmas cards and letters every year.

The handwritten message said she died in November, after learning in September she had lung cancer and making the choice not to undergo treatment.

“Mother decided to choose quality over quantity of life,” he wrote, adding she opted for hospice care rather than chemotherapy.

That brought to mind my favorite college professor who, in her 80s, suffered from congestive heart failure and faced the prospect of a life on kidney dialysis.

She rejected treatment and also chose to die under the care of hospice workers.

A friend in his late 60s, who had lung cancer, tried chemotherapy but could not tolerate its side effects.

Determined to have a lucid, full life until the end, he stopped the treatments and chose in-home hospice care. He said he wanted to remain in beloved familiar surroundings, which brought him a measure of comfort and peace in his final month of life.

Three relatives of mine went a step further when faced with terminal illness and suffering. They decided when and how they would exit this earth and remained in control until their last breaths.

In an ideal world, all patients should be allowed to determine where, when and how they die. Self-determination and control are critical to the dying process.

In research studies, almost 90 percent of people in the United States say they would like to die at home. But, in reality, about 80 percent die in health care facilities.

Most of us say we would like to pass quickly, in our sleep. But very few people die suddenly.

Almost everyone wants to die without pain and prolonged suffering, yet many folks are kept alive, in tremendous pain, well past the time they would wish their lives to end.

To have the death we want, we need to take steps now, while we are living, to spell out the kind of end-of-life process we desire.

Knowing our options and planning in advance can mitigate death’s sting and spare our loved ones the pain of making choices for us under duress.

The most important thing we can do now is to sign an advanced directive and name a health care proxy, someone we trust to carry out our wishes if we are incapacitated.

In this legal document we can specify what measures we want for pain management, which visitors we want to see (or not see) in our final days, how much life support, if any, we wish to have, when to stop medical interventions, such as breathing machines, forced feeding, dialysis and defibrillation, and more.

Without such instructions, doctors have an obligation to, and are trained to, provide life-sustaining treatment. They are legally bound to keep us alive as long as possible with the latest medical technology.

Right now, in our living room, instead of a hospital waiting room, is the time to make choices about how we want to spend our last days.

Since none of us can avoid dying, our goal should be to experience a good death, with dignity, on our own terms. Ignoring the subject will not spare us from that final journey.

Ironically, this is probably the most important decision we will make in our lives.