I quilt for my enjoyment. If I'm making a quilt for someone, I consider their personality and preferences. Otherwise, I do whatever strikes my fancy. I've got several tops waiting to be quilted. Some will have plain backs, some a simple pieced design. I let the quilt "speak" to me and go from there.
I admire the ability to make a real double sided quilt (such as the one postal packin mama made, shown above), but it's not something I would attempt. I think it's nice that we can all do things in our own unique way while still appreciating the skills of others.