The lead article in the latest edition of the Journal of the American Medical Association states that, according to a recent study of 900 cancer patients, 80% over estimated their life expectancy by six months.

And while having a positive attitude is not necessarily a bad thing, it resulted in patients choosing aggressive therapies which not only did not extend their lives but, and more importantly, influenced their not choosing comfort care and hospice services.

This data is discouraging but it is also a call for pastoral care givers to step forward and provide leadership. The time has come for us to reexamine our treatment of the dying and revision what is included in our concepts of total health care. It is time to finally respond to a very important need in our health care system: helping patients and their families and friends prepare for death.

We need to admit that most patients will need help to not only accept the reality of their own death but also to be able to respond to it in meaningful ways.

Further, doctors need to find better ways to communicate the facts and implications of their patients' terminal conditions.

While it is understandable that folks want to hold on to hope as long as possible and to try any treatment that offers a chance for longer life, it seems that there comes a point where efforts to cure or extend life need to shift toward accepting death and dealing with the issues connected with final endings.

Pastoral care givers have a special expertise in this area and are an underutilized resource for both patients and doctors to approach this unspeakable topic. However, pastoral counselors cannot do it all.

What I am suggesting is that our consciousness concerning our approach to death must be raised. To do this, chaplains and doctors as well as social workers and various other professionals and organizations must examine the structure and process of how patients are told when their condition is understood to be terminal. I also think that folks involved with terminally ill people need to look at how options are presented and evaluated .

This is obviously a very difficult subject to raise.

Nonetheless, if we hope to grow as a society, we must learn to talk about important issues and work together to care for one another throughout the entire journey of our life on this planet.

While some may say that this kind of effort is essentially spiritual and thus the job for our religious communities, I feel that kind of compartmentalization is inadequate to cope with the scope of the problem. It is necessary to expand our view for patient care beyond institutional religion. Not because it is not their job but because the task is just too big to be left to them.

Coming to terms with end of life issues are relevant whether one belongs to a particular religious tradition or not. Dealing with one's own death is not something that is simply for "religious" people. It affects us all.

I believe the problem the JAMA study exposes is larger than simply how doctors or chaplains talk to the dying because it involves our society's attitudes about death and its penchant to avoid and deny it.

For many turning to hospice and spiritual care may be interpreted by our present mind set as giving up or giving in. Many suffer from the Vince Lombardi approach to life. (Never give up, Never accept defeat.) While his outlook may have been good for winning football games, life is not a football game.

For years many writers have decried our cultural flight from death. The latest data is further evidence that the aversion continues but I do not believe that this attitude must accepted. Perhaps, as we move toward the new millennia, we as a nation need to risk to embrace the final mystery in a more direct and open way.

From a faith perspective, dying is no losing nor is it a defeat. To regard it as such means that folks will miss out on priceless and irreplaceable opportunities to say goodbye and reflect on the ultimate meaning of their lives.

Rather than simply obsessing about how long we can live, no matter under what circumstances, we may want to consider the meaning of our lives and the way we wish to greet the end time.