Oregon is home to the first death-with-dignity law in the U.S., and a new study shows that this state may have the best approach to allowing terminally ill patients a choice in where — and how — they want to die when it comes to quality of life palliative measures versus aggressive attempts to prolong life no matter what the cost or quality, Stat News reports.

You should always be able to choose what care you want, how you want it delivered and where, no matter at what point you are in your lifespan. Too often, your choices diminish the second you walk in a hospital, especially if you enter through the emergency room (ER).

Unless you have advance directives, once you’re in the ER, it’s too late to make end-of-life or continuing care decisions, as they will probably be made for you, especially if you’re very sick. Nearly 10,000 people who visit emergency rooms die within the first seven days of their visit, with the elderly having a greater risk to suffer a disability in the six months following the visit — which proves that now is the time to plan strategies to help prevent visits to the ER and take defensive steps if you need to use emergency care, such as taking an advocate and choosing a hospital before it is needed.

Other things you can do include embracing choices that reduce your risk of health emergencies, such as reducing your sugar and net carb intake to optimize your mitochondrial health and reduce your risk for insulin resistance, type 2 diabetes and cardiovascular disease. Massive sugar addiction can also result in obesity as well as cancer cell production, depletion of brain power, and shorter lifespans, all of which can end up putting you in the ER.

Surprisingly, your attitude can even keep you out of the ER: Research shows that a positive outlook on life is the most influential factor in longevity studies