I agree that the culture around end of life care needs to change towards acceptance of the inevitable. I can understand why researchers would want to explore the role of physicians in driving end of life care, but this is a situation where when you start to measure something, it changes. Just because they are measuring physician's impact does not mean it is the major contributing factor.

My observation of physicians post-COVID is that they are less willing to advocate for more end-of-life care when the patient is unwilling to help themselves.

I think Americans at large, more than physicians, need to change how they view death and dying. Physicians egos are not the reason we spend more on end-of-life care than any other country.