Complex social, cultural, economic, geographic, and health system factors and impediments contribute to this discordance between how doctors treat their patients and how they themselves (and the majority of surveyed Americans) wish to be cared for at the end of life. We are experiencing the greatest demographic shift in U.S. history. According to current projections, by 2030, 20% of Americans will be more than 65 years old. Cultural diversity is also increasing, as is the percentage of people with one or more chronic illnesses. It is therefore imperative that the medical community listen to patients and recognize that their end-of-life preferences may change over time, especially as longevity increases. The goal should be to help people receive care in keeping with their personal preferences as they near the end of life.