Over 55 million people died in 2019.1 The vast majority died in low and middle-income countries (LMICs) without even basic access to palliative care, an essential component of universal health coverage. As a result, many of these individuals died in pain, and with significant distress. Yet, living in a country with, or even receiving, specialized palliative care does not guarantee a high-quality end-of-life experience. Despite a lack of systematic reporting in most countries, there is overwhelming evidence that even high-functioning health systems often fail to deliver on aspects of end-of-life care that are important to patients with advanced illness and their caregivers.