I think a lot of times they can't "ask really loud" because they're mentally impaired and sick. Also, it sometimes happens that people have pension benefits that stop or substantially decrease when they die, such that their spouse (who is likely to have legal control over medical decisions) has a giant financial incentive for them to be kept "legally alive" but stored out of sight and mind in a inexpensive facility somewhere. In such cases, if you're being uncharitable by imagining the capacity to calculate on the part of seemingly stupid people, then "feeling icky" is just an emotionally plausible cover for "pursuing money despite the moral horror involved".

Legal bright-lines combined with tragic and unforeseen circumstances can produce kind of bizarre and horrible outcomes that no one has much incentive to talk about when they personally find out about them. Since they aren't much discussed, they don't enter into people's calculations very much... which helps them remain "unforeseen" for many people (and thus potentially increases the tragedy, due to lack of advance planning). Its like an ugh field, except functioning at the interpersonal level where epistemic hygiene starts to be relevant, rather than being a matter of confused stuff going on in a single person's head.