Why People Are Talking to Their Doctors About Death

Published April 10, 2016

Most people don’t like to think about the end of their own lives. When they do, they imagine dying peacefully at home, surrounded by loved ones. But that’s not what usually happens, unfortunately. Today in the US, most people pass away in nursing homes or hospitals.

Wishes vs. Reality

Survey after survey, not only in the US, but in the UK as well, shows that large majorities of people favor dying at home: as many as 90% in some surveys; no lower than 70% in others. But only about 25-30% of Americans die at home. Why the disparity?

Part of the reason is a lack of planning. Too few Americans discuss end-of-life issues with family, and even fewer discuss it with doctors. But that’s about to change.

As of January 1, 2016, Medicare will now reimburse doctors for discussing “advance care planning”, which is just another way of saying “a frank discussion with your doctor about your wishes”. Many doctors feel comfortable discussing end-of-life plans with their patients, but many do not. The hope is that the new reimbursement rules will encourage doctors who are on the fence to broach the topic with seniors in their practices.


Because doctors and patients aren’t talking about end-of-life options, many people aren’t aware of the options available to them. Seniors might mistakenly believe that they have to be perfectly healthy to die at home, as paradoxical as that sounds. They might believe that if they have any kind of medical issue, they will have to be cared for in a hospital.

If they had the chance to have a discussion with their doctor, seniors would learn that they can be cared for quite well outside of the hospital, often in their own homes, where they feel most comfortable.

Palliative Care

One option that doctors and seniors could discuss at these appointments is palliative care. Palliative care is designed to make a sick person as comfortable as possible during a chronic or terminal illness. Whereas the acute care received in hospitals is designed to restore the patient to full health and function, palliative care is designed to maximize quality of life and comfort and to minimize pain and discomfort. Receiving palliative care does not mean that a patient’s disease is not treated. To the contrary, patients receiving palliative care can be treated with any kind of medication, even chemotherapy. Palliative care is focused on the whole person, not just the disease. The emphasis is on all the needs of the patient: physical, emotional and spiritual.

There are many places where you can receive palliative care. You can live at home and get care as an out-patient at a hospital. Or you can be treated in a long-term-care facility. Finally, you can get palliative care exclusively at home. These are all options you can discuss with your doctor.


Hospice is a special category of palliative care. Palliative care can be given at any age, any stage of illness, chronic or terminal, for any length of time. Hospice care is particularly for people who have a terminal illness with a short life expectancy, usually six months or less. Hospice is focused entirely on maximizing a patient’s comfort. Like palliative care, hospice pays attention to the whole person, not a disease. Most people receive hospice care in their own homes.

Get the Conversation Started

Even though doctors are now being paid for having advance care planning discussions with their patients, they may not initiate those discussions. Now seniors can remind their doctors that they can talk about end-of-life and get paid for it. It’s best to get these conversations started well before you’ll ever need these services.