I think that physicians are equipped to have these discussions but are discouraged from doing so, especially in the wake of the post healthcare battle "Death Panels" scare that was so pervasive.

That's actually a great point, it's mostly the older physicians I've seen who are uncomfortable having these discussions. The medical-legal landscape scares off many doctors from wanting to have this discussion though, you can see the hazards of it even in the article. It's all about documentation.

If you are big pharma or a med device company you lobby hard to keep life extending policies in place. More of their products are consumed in the last days, weeks and months of life than the whole rest of life combined. (Okay, I made up that stat, but I would bet it's true). It's all about money, including the money the hospitals and physicians can make. It's not about what is best for the patient.

While this is a pretty cynical view I can see where it's coming from, and the last few years of life account for well over 60-70% of total healthcare expenses. A lot of physicians do want what's best for the person, especially if they've been treating them for years. You can argue the surgeon doing the tracheostomy or placing the G-tube doesn't really care, but more often the primary physician either publicly or privately will voice concerns or hesitation. I really don't think people are adequately informed. You always hear that one story of the doctors wanted to pull the plug but little betsy against all odds survived and now shes an astronaut! People don't like dealing with the harsh realities of end of life care because it's uncomfortable to do so.