Death is inevitable. Dying badly is not. That's why end-of-life issues deserve the higher profile and broader perspective just recommended in a new report from the Hastings Center, a bioethics think tank.

The report cited substantial progress over the last 25 to 30 years in improving care people receive at life's end. People today, for instance, have more control over the kinds of medical technology that will be used to sustain life. And more people die without needless pain and while being surrounded by family and friends.

However, the report concluded that laws, litigation and other measures from the past still leave too many Americans with poor care. These individuals are dying "bad" deaths -- without having their wishes honored and without all possible dignity and comfort.

Pittsburgh health-care providers are working on solutions to these issues, as members of Gov. Ed Rendell's Task Force for Quality at the End of Life in Pennsylvania. Their recommendations for improving the care of the dying throughout the state are due early in 2006.

The Hastings report was among many that have noted flaws in existing approaches, which place heavy emphasis on laws and regulations. States rushed to pass legislation allowing living wills, for instance, but experts agree living wills have not met expectations.

Living wills enable individuals to indicate the kind of medical care they want, if incapacitated and unable to communicate as death nears. But few people have them and, all too often, the documents can't be found when needed, or are ignored by health-care providers.

The nation needs a more coordinated system for assuring that every person receives good end-of-life care. The Hastings report suggested new approaches that focus on helping family members and physicians become more effective decision makers. That role is especially important for people like the late Terri Schiavo, who no longer are capable of making their own decisions.

Just getting the topic of death out in the open and up for discussion is immensely important. The first step in assuring a good death is talking with loved ones and your own doctors to make your wishes absolutely clear.