America, the land of vitality, youth and independence, has a marked distaste for discussions involving end-of-life issues. Death? It only happens to other people.

Yet millions of baby boomers continue their inexorable march into old age and death. Vast numbers of the World War II generation are succumbing daily to the Grim Reaper, but rational conversations about death and dying are still just a whisper.

The cost of healthcare is already astronomical. End-of-life care consumes 10 to 12 percent of the total U.S. healthcare budget, and 27 percent of Medicare's annual $327 billion budget is spent caring for people in their last year of life.

Crucial decisions involving real people nearing death require thoughtful deliberation, a consideration for the reality of the situation and an acceptance that death, for everybody, is inevitable.

Why have we, as a nation, made this so difficult?

Advances in medical technology have made it possible to keep a body "alive" for months, if not years. The shell of a human being -- often with some involuntary movements that signal life to the truly optimistic, kept functioning artificially -- creates controversies within families, often causing fractures that never heal.

Why is it so hard to say goodbye? Why can't we allow people to die peacefully, or at a time of their choosing if they are terminally ill? Why do we have to exhaust all means available, emotionally, financially and medically, to cheat death for a few moments more? Is there never a time where death is the least objectionable of the alternatives?

Nearly two years ago, I stood over my father's hospital bed. His prognosis was grim, but there was still a slim chance of recovery. In his last moment of lucidity, he told my mother, quite clearly, that he loved her.

A thickly muscled, proud and vital man with a restless and unorthodox intelligence, he embodied strength. Missing in action behind enemy lines in World War II, he battled back, earned a Bronze Star for courage under fire and barged through the rest of his life with a fearsome impatience that could be misinterpreted as unforgiving to those around him.

Now he was agitated and incoherent, a shrunken old man picking at his blankets, ignominiously tethered in restraints to keep him from ripping out the many tubes running into his body, monitors recording his every breath, every beat of his heart.

Years earlier, without provocation, he had given me, his younger daughter, the monumental responsibility of managing his life when he was no longer able. Me. Not his elder daughter, the medical doctor. Me.

The youngest grandchild in a very large family, I have seen death up close and personal since I was a small child.

Our family, all hearty Midwesterners, mostly farmers, always had a pragmatic attitude about death. Death happened with regularity -- to animals, to neighbors, to family members you loved. You accepted it, mourned, moved on. Part of life, death was woven seamlessly into the tapestry that makes a family.

Although he was a man of many words, my father and I had rarely discussed anything important, but I knew without a single doubt how he felt about life and death. When the time came, he expected me to make the right decision as his daughter, using my heart.

The call came three days after I returned home. The doctor told me that the prognosis had changed -- that after a massive cerebral accident, my father wasn't going to get better.

What to do now?

The modest community hospital on the plains of western Kansas did not possess sophisticated medical technology. Would he want to live in a vegetative state long after his life was gone because, even there, they could manage that? After consulting with my sister, who wanted him airlifted to a more progressive hospital, I knew I had to find the strength to let my father die.

Three days after I requested that his fluid support be withdrawn, my father died quietly. My mother, already hospitalized and mercifully lost in the deepening fog of dementia, was at his side, just as he would have wanted. His death was peaceful, the two of them together as they had been throughout their lifetime, their hands clasped.

My father trusted me with the ultimate decision. I made it.

I know he would have been proud.