American medicine's success at fighting disease and extending life has created a new problem. That is, the vast majority of patients can now expect to die in a place (a hospital or nursing home) and in a way (with increased quantity, but reduced quality, of life) that most wouldn't choose if only asked. Talking about dying, which is as natural as birth, is now taboo. And, the reality is patients and families are suffering needlessly. It is a problem we never intended to create and one that must be solved, but how?