“Die, my dear doctor?” Palmerston asked on his deathbed. “That's the last thing I shall do.” Very shortly afterwards he did. At home, in his bed. In the 19th century most people did. Today most of us say that we, too, wish to die in our own beds, in familiar surroundings, warmed by the love of our families and by our memories.

In practice, fewer than one in five people succeed in doing so. The Government has decided that it wants to help more of us to die where we wish, with as little pain as is feasible, and with the dignity and respect we deserve.

The Government's aim is wholly desirable. How we care for our sick is a yardstick of any civilised society. How we die is an essential but woefully undiscussed element of how we live. Enabling more people to die at home is a goal that will not be easy to achieve, and not just because it will be costly.

Of the 500,000 or so people who die each year in England, almost two thirds are over the age of 75. The large majority of these deaths arrive as the final chapter of a period of chronic illness, such as heart disease, cancer, stroke, chronic respiratory disease, neurological disease or dementia. Perhaps inevitably, then, given the need for acute medical treatment for such illnesses, some 58 per cent of people end up dying in NHS hospitals - the last place they would choose if they had any say in the matter. Just under a fifth die at home, a smiliar proportion in care homes, and just 4 per cent in hospices.

Research projections indicate that if current trends continue, fewer than one in ten people will die at home by 2030. Reversing this trend poses challenges. Enabling more people to die at home changes not just the final phase of their medical treatment. It triggers a different process of loss and grieving. It imposes upon families duties of care that many families might not be able, financially or emotionally, to meet. And while most people would prefer to be cared for at home, they also want to be assured that such care will be of a high quality. But they would feel uncomfortable if they sensed that the price of their comfort was their being a burden to their loved ones and carers. This leads some people to opt for a final spell in a hospice, in order to spare their family the responsibility of nursing them.

Caring for a patient on the brink of death imposes heavy responsibilities. Administering palliative treatment can be tricky. Not every spouse, child or parent would feel confident in correctly dosing pain relief. What would be the medical and legal consequences of an accidental overdose? Doctors not only help people to live, they commonly, quietly, help people to die as peacefully and as gracefully as possible. This is not an aspect of care one hands over lightly to next of kin.

The financial arguments are also mixed. Shifting more care into the home will save money for the NHS compared with the cost of keeping the dying in a hospital bed, under the 24-hour supervision of doctors and nurses. On the other hand, an à la carte menu of help for hospices and round-the-clock rapid-response community nursing could prove enormously expensive. The Government has pledged £286 million for such palliative care, but it also admits that what it calls end-of-life care is measured in billions, without explaining how the gulf between these sums will be bridged.

Somerset Maugham considered death “a very dull, dreary affair”. His advice was “to have nothing to do with it”. But sooner or later we all end up having to have something to do with it. So the Government should be congratulated for instigating a discussion on how people negotiate their death. Part of this discussion, though, should acknowledge that just because three quarters of us say we want to die in our own beds, that does not make it always possible or desirable.