Witnessing too many ICU dramas made Karl Ahlswede, MD, so interested in end-of-life issues that last summer he made a highly unusual career move. He gave up his surgical practice at Lankenau Hospital in Wynnewood, PA, to start a business helping clients write advance directives and working as an independent adviser when death approaches. People need to think about how they want to die and talk with their families long before they get to the ICU. While more and more hospitals are forming teams of caregivers to help patients at the end of life, medical counseling about death remains a hot-button issue. The infamous "death-panels" rhetoric from Sarah Palin and others effectively killed an attempt to provide Medicare coverage for end-of-life planning in the health-care-reform bill.