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In the western world, two important life events, birth and death, most often occur in hospitals. Among professional caregivers and the lay public, there is a growing concern that excessive and scarce resources are used to provide unwanted and futile life-sustaining medical treatment for patients at the end of their life. Concerns that death is unnecessarily prolonged by technical and pharmacological interventions are frequently heard. Consequently, decisions to forego (further) treatment are made more often.

The worst is yet to come. Many elderly patients with chronic terminal illnesses will eventually die in the emergency department