Doctors make the decision when to *offer* palliative care. Doctors are not out there shipping off people when there is still treatment and hope. This is *not* rationing care. It's the difficult situation when a patient has a terminal illness and treatment is futile. People are confusing the situation.
The patient ultimately makes the decision. Often, the patient decides to switch to palliative care when the treatment is too much (that's what my dad did--chemo was too brutal, was not a cure and was only buying a little time). Cancer treatment is toxic and painful. When a patient decides to end medical treatment and seeks palliative care (primarily pain relief). then the patient goes to hospice. The end of life counseling is to help coordinate the palliative care (hospice, home nursing care, etc.).
Some people have this idea that the doctors will somehow collude with the insurer to withhold medical treatment and bus the patient off to hospice. An over active imagination? A fear of hospice? Hospice is a wonderful place for giving palliative care and adequate pain relief. The patients need morphine, which slowly shuts down the patient's organs. It's a situation that needs special medical care. The doctors and nurses there make sure that the patient is comfortable and that the patient's emotional and spiritual needs are met.
If you have been fortunate enough not to have to go through this with a loved one, you are lucky. It's a traumatic experience for the patient and family, no matter how well planned and assisted.
People need to be grown ups and be able to discuss this. We're all going to die someday. Yes, FB has an app to tell you when you're going to die, if you're interested in that! LOL!