With his book "Dying Well," Ira Byock hoped to explore why Americans were spending their last hours in pain, in hospitals and often alone. Twenty years later, Byock has found little improvement. "More people understand dying and illness is a time of life they can make the best of, but the desire to not be dead remains as strong as ever," he says.

The desire to stay alive

As medical technology has advanced, it has offered impressive benefits —  but Byock notes it has also made more complex choices for patients and families. "While the use of hospice care is growing, we're seeing people are getting into it very late and using more high-tech treatments to try to stay alive," he says. "Far more than want to end up in the ICU during the last weeks of their lives."

"Palliative care can help you live better and longer."

It is possible to avoid that grim fate, however. "People must advocate for themselves," he says, adding that medical education has largely overlooked training physicians in how to help patients face death. "As well intentioned and technically sophisticated as doctors are, the health system is not set up to guide patients through this difficult stage."

Palliative care as an option

He urges patients who've received a tough diagnosis to contact a palliative care doctor. While patients often reject the idea as embracing death, he says the opposite is true. "Palliative care can help you live better and longer, because in expertly treating pain and making sure patients are eating and sleeping better and getting around more, plus addressing unspoken fears and concerns for their family, people simply do better."

He also urges everyone to choose a representative who can speak for them should they become incapacitated, and says there are four things everyone should say to their loved ones before they die. "Please forgive me, I forgive you, thank you, and I love you. For many of us, that's just stating the obvious, but it has so much value."