Conflict of interest between physicians and pharmaceutical companies raises questions about the ethics surrounding these relationships.

It’s the financial relationship that raises questions about the influence of drug companies on prescribing patterns or research results of doctors.

Nationwide, pharmaceutical manufacturers routinely pay medical professionals to assess a new product or to help contribute to the drug company’s sales. The companies fly medical professionals to seminars and conferences and may also pay speaking fees. State-employed doctors and researchers are generally no exception, though they are supposed to comply with their individual institutions’ conflict-of-interest policies.

Conversations doctors don’t want to have include the end of options for the terminally ill.

Whether it’s lack of training or cultural resistance to discuss death and dying there are huge gaps in patient care at the end of life.

In this country, we tiptoe around the D-word until so late in the game that even now, when more than 40 percent of Americans die under hospice care, about half do so within two weeks of admission. Even expert hospice teams can’t provide many of the elements of a good death — and they believe there is such a thing — in mere days.

We can blame some of this evasiveness on physicians, trained to save lives. But families bear some responsibility, too; they may not seek or seem to welcome a frank assessment. Either way, while many patients do have breakpoint conversations, ignorance often rules.