DURING a CNN presidential town hall early this year, an 81-year-old man from Concord, NH, with phase IV colon cancer, Jim Kinhan, asked Hillary Clinton what she could do to “help advance the respectful conversation that is needed around this personal choice that people may make, as we age and deal with health issues or be the caregivers of those people, to help enhance their end of life with dignity.”

Jim Kinhan is not alone.

US society is in the midst of a profound shift in attitudes toward end-of-life healthcare. We are increasingly aware that too many suffer needlessly in their dying. Too many endure tests and treatments that increase suffering but do nothing to extend life. Too many carry memories of the pain, confusion and agony of a dying loved one.

Every day, 10,000 people turn 65. The proportion of the population reaching age 85 is 48 times larger than a century ago. Increased life expectancy brings challenges of advanced illnesses among the aged. The US medical system focuses almost exclusively on extending life at any cost, often at the expense of its quality. The Centers for Medicare and Medicaid Services reinforce this focus by reimbursing doctors generously for complicated tests, ICU stays and medical device implantations, but not for conversations and comfort care.

People who do not communicate their values and priorities as illnesses advance often pay dearly for this failure. Lacking clear guidance on how an individual weighs the quality of life against its absolute duration, physicians often assume the latter, so they propose agonizing tests and treatments that steal life’s joys as they prolong the dying process.

Most Americans want to die at home, peacefully and with loved ones close by. But nearly 40 percent die in a hospital, and almost 60 percent of these hospitalizations include an ICU admission.

As noted in an issue of the Journal of American Medical Association, devoted entirely to end-of-life care: “ICU care in the United States at the end of life appears unwanted, expensive, and futile.”

In other words, US healthcare system is failing to deliver what people need as they approach an inevitable and imminent death. Polls shows people across the country increasingly expect candid information, more options and more personalized care at the end of life.

Empowered patients ask more and better questions. They weigh treatment decisions carefully and they understand how an ICU admission, with its cascade of tests and treatments, impacts the end-of-life experience.

People need greater access to information and options as the end of life approaches. And they want their national and state policy makers to address this need.

No one should suffer needlessly at the end of life. Policy solutions should be designed to minimize suffering and maximize comfort.

Lee is an attorney and President of Compassion & Choices, the nation‘s largest end-of-life choice advocacy organization. Callinan is Chief Program Officer for Compassion & Choices. Copyright: American Forum. Shanghai Daily condensed this article.