In Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life, an Institute of Medicine (IOM) committee (which we cochaired) concluded that the U.S. health care system is poorly designed to meet the needs of patients and their families at the end of life and that major changes are needed. We need to begin by fostering patients' ability to take control of their quality of life throughout their life and to choose the care they desire near the end of life.4 The committee recognized that these goals could be achieved only by making major changes to the education, training, and practice of health care professionals, as well as changes in health care policy and payment systems, Simultaneously, individual and public education would have to be radically reformed to reshape expectations and allow patients and clinicians to have meaningful discussions about end-of-life planning (see Summary of IOM Committee Recommendations).