"Most Americans can't afford a comfortable death. More than likely, their savings accounts won't hold up after intense hospitalization. And, as the insurance system now works, benefits will cover ample surgeries and procedures, but once those limits are met there is nothing left for palliative care . . .

"At least three barriers block the way for a more comfortable death . . . (1) The health-care system fails to offer an institutional structure to support appropriate choices for dying patients. (2) Insurance mechanisms fall short of providing adequate support beyond high-tech care. (3) American culture embraces high-tech medicine while harboring an overwhelming fear of painful death. Discussions of palliative care rarely enter into the picture."