In study after study after study, researchers bemoan
persistently mediocre rates of advance care planning.

What he meant is that medical treatment decisions have been made for every Minnesotan (and every other American too) should they become incapacitated. The problem is that most of those decisions were not made by the patients themselves. And in many cases they are not the same treatment decisions that those patients would have made for themselves.
In short, failure to make any affirmative choice is still a choice. It is a choice for the default option: continued aggressive treatment.
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