Hospitals and doctors make more money by aggressively treating terminal patients than by keeping them free of pain and letting them die with dignity. Some doctors derisively call the practice “flogging” — as in, beating a dead horse.

Medicare, which paid most of Massco’s bills and is the nation’s largest health insurance program, spends about $113 billion a year, or a quarter of its budget for people 65 and older, to treat patients during the last year of their lives. As lawmakers argue about ways to cut costs, many experts say the government wastes billions of dollars on unnecessary care for dying patients.

Doctors and hospitals typically err in favor of aggressive, expensive care, according to Goodman, other experts and medical studies. Too often, physicians fail to ask patients how they want to die. Then, even when people choose to die without intensive care, their doctors might order it anyway.