There is a generational sea change occurring in medicine and the younger physicians realize more than ever the inefficiencies and the harm that come with extending life as long as you can without a thought to quality of life and cost. If you are big pharma or a med device company you lobby hard to keep life extending policies in place. More of their products are consumed in the last days, weeks and months of life than the whole rest of life combined. (Okay, I made up that stat, but I would bet it's true). It's all about money, including the money the hospitals and physicians can make. It's not about what is best for the patient.The US provides far too much extraordinary care at the end of life, not because it's useful but rather because it's available and physicians aren't equipped for the palliative care discussion that needs to happen
I think that physicians are equipped to have these discussions but are discouraged from doing so, especially in the wake of the post healthcare battle "Death Panels" scare that was so pervasive.