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A health care policy that puts the ending first

TORRANCE, Calif.—Rod Hochman vividly remembers watching his father die the wrong way, laid out by a stroke at age 78, hooked up to a ventilator and an intravenous drip in an ICU, his last hours spent in a hospital. It was the most aggressive care modern medicine could offer, and the family later came to understand that it was unlikely to save him. It was not how he wanted to end his days.

Millions of Americans have endured similar experiences, but Hochman is in a rare position to do something about it. He’s a doctor and CEO of Providence St Joseph health care system, one of the largest nonprofit health systems in the country.

Over the past year, his 51-hospital chain has undertaken a systematic effort to get every single patient age 65 and older—in other words, every Medicare patient, as well as younger people with serious diseases like cancer—to lay out and document their wishes for end-of-life care, and to designate someone to make decisions on their behalf if they can no longer speak for themselves.

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