Ask people what they want at the end of their lives, and overwhelmingly the answers will revolve around comfort, dignity and time at home with loved ones.

Yet the U.S. healthcare system often thwarts these wishes.

Most Americans say they want to die at home, but only one-third do. What could be an intentional last chapter may instead become a roller coaster of hospitalizations and decisions made with incomplete information.

News headlines reflect the challenges of facing the end of life in crisis mode. Stars such as Nicole Kidman have been open about their own negative experiences with a loved one’s care. After her mother’s death in 2024, she decided to train to become a death doula, a nonmedical guide who helps dying people and their families in their last months to hours. Unfortunately, these crisis scenarios are happening to millions of families each year.

What causes these situations, and how can people avoid them? As a medical sociologist and a death doula and master’s student in mental health counseling, we have been trying to answer such questions through years of research and hands-on work.

In our discussions with patients, members of their families and healthcare providers, we found that people can avoid some of these end-of-life surprises. Two relatively unexplored resources can help by centering care and education while also encouraging people to make choices that are best for them and their loved ones.

Human costs of a ‘fix-it’ medical approach

Research shows that the healthcare system’s emphasis on the length – not quality – of life introduces preventable suffering into American experiences of death.

In this context, dramatic mismatches exist between what people want at the end of life and what the healthcare system provides. A 2017 Kaiser Family Foundation survey found that a majority of Americans say that patients and their families should have the biggest say in medical decisions. Yet half of those........

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