This article notes that 28% of Medicare expenditures are incurred in the last year of life. It discusses 3 major approaches proposed to lower financial, emotional & physical burdens: rationing care to the elderly, use of advance directives, & physician-assisted suicide. It also presents a 2-prong plan of recommending less-technologically-intensive care & instituting care in an environment conducive to its implementation. The challenges of implementing changes are discussed. (39 Refs.)