This was my take, too -- there are lots of players, many of them have strong incentives that are misaligned with many patients' priorities, and for a patient an

This was my take, too -- there are lots of players, many of them have strong incentives that are misaligned with many patients' priorities, and for a patient and their caregivers to even understand what decisions will help them have the end-of-life care they want is quite difficult. Even when the patient has really good advocates who have the expertise required (like their primary care physician in the article), the system is so fragmented that very few of the professionals involved in these decisions talk with each other... so the advocate may not be able to help at all at the critical moment. These are hard problems to solve; I'm proud to be working on part of the solution (the fragmented patient record and broken communication), but there's a lot more needed before this kind of experience will be a thing of the past.