You might think that making provisions for dying was the one thing human beings would plan well, given the certainty that all of us must die one day. But in America especially, the practicality of our lives deserts us at the last.

In some ways, modern attitudes toward dying haven't adjusted to modern times. A hundred years ago, people died often of acute infections (in 1900, life expectancy at birth for Americans was 47.3 years). Today, thanks again to medical progress, they tend to live longer and die of progressive chronic diseases such as cancer and heart disease (life expectancy is estimated at more than 77 years).

But for all the technology, the medical establishment has been slow to adjust to the fact that heroic life-saving measures are not always sensible or even compassionate in older patients who are clearly in their last days.

As the just-released report by the Task Force for Quality at the End of Life says, "The current health-care system evolved to provide care for acute illnesses, but it is poorly prepared to provide comprehensive, coordinated care for those with a serious chronic illness or at the end of life."

The task force, convened by Gov. Ed Rendell under the leadership of Secretary of Aging Nora Dowd Eisenhower, was spurred by a 2002 foundation report on dying in American today. This found fault with many states on end-of-life issues, including Pennsylvania which was given an overall grade of D.

But the subject clearly was ripe for attention in a state where 15 percent of the population is 65 years or older, compared to 12 percent nationally. These figures, along with facts cited earlier, are contained in the report, which comes with 160 recommendations.

As the report says, advances in science and longevity have left untouched a large reservoir of unrecognized suffering for patients and their families. It implies that the cost comes not only in pain, stress and demoralization and loss of dignity but also in dollars and cents. Medical bills in the last year of life tend to pile up and be much more expensive than for preceding years.

It is easy to understand why. Fewer than a quarter of Pennsylvania residents die at home, although most Americans, the report says, prefer to die at home. Despite the wonderful work done by the hospice movement in bringing dignity to death, hospice use is low -- only 21 percent of Pennsylvanians over 65 use hospice care in the last year of their life.

The challenge to reform palliative and end-of-life care -- one of the task force's primary goals -- is not an easy one, having many dimensions. As the Post-Gazette news story on the report pointed out, the host of recommendations may be too much for the health-care community to digest and act upon.

It would be a shame and a waste if this report on dying died its own quiet death. The recommendations are meant to cure situations that should not be tolerated.

It is illogical that medical payment systems are not geared to support the needs of people with chronic and advanced illnesses so that they must remain in a hospital undergoing expensive procedures that may be futile and unnecessary. It is unconscionable that "not nearly enough" Pennsylvania hospitals have palliative care programs to help make patients comfortable and that the state is "severely lacking" in palliative care-certified physicians and nurses to staff such programs.

This report should be the start of a serious conversation in the medical community. It is hard to die, but too often in Pennsylvania it is harder than it needs to be.