The fundamental issue I found ... was not the percentage of people at the margin who really do want to spend their last days on a ventilator with a feed tube and dialysis machine, or getting knocked down by a fourth round of chemotherapy with a minuscule chance of helping. Perhaps there ARE more of these folks in America than elsewhere. But the crucial problem is that for most people, this is misery. They don’t want this when they really get down to thinking and talking through it. The failure of our system is that we are not good at helping people sort out what is most important to them when they are dying and then helping them achieve it.