Never in human existence has dying been more complicated. Before the onset of modern medicine, most people died quickly from an acute event such as trauma or the effects of infection. Today most deaths are a slow process of decline stemming from chronic medical conditions – heart failure, diabetes and dementia, among many. In Massachusetts, roughly 80 percent of seniors die in the hospital, and only about half participate in any type of end-of-life care planning. Despite the often long, drawn-out process of dying today, many patients, families and medical providers never discuss it. As a result, dying in America has become a disjointed, problematic and costly process that often causes unwelcome suffering.