Many people avoid planning for their own end-of-life care and do not exercise an active choice. Choices are then made for them. This is a serious outcome for anyone, but fundamentally, there is a developed mechanism for non-disabled persons to make their wishes, preferences and desires known. However, many people with intellectual and developmental disabilities (I/DD) are denied the opportunity to exercise choice altogether. Our most vulnerable citizens may have even fewer opportunities than anyone else at the end of life, for a variety of complex reasons.