Another factor is the cost of litigation or fear of litigation. A major cost center for the medical community is insurance.

Yes, we need to change our end of life thinking. I knew a fellow with terminal cancer. He had been through all of the then state of the art procedures and experimental trials, the end was near, everyone knew it, he wanted to die at home. Then on one particularly bad night, he was whisked to the hospital and thrown into intensive care. Likely he would not have survived the night without the tubes and frantic things done in intensive care. As best he could, he asked that this not be done, but his last wish was ignored. About a week later he died in the intensive care unit. I wonder how many lives could have been positively impacted if the resources tied up in that final week could have been diverted to preventive medicine or treating conditions that could have been cured with relatively simple procedures that were out of reach for the uninsured or uneducated.