Rather than engaging the patient and family in a personal way, many physicians pursue medical therapy in the narrowest sense during the terminal illness of their patients and wage against inevitable death a therapeutic battle that can be graceless, futile, and ugly. As a house officer and now as an attending physician in a teaching hospital, I have seen far too many dismal deaths because medical treatment, although well-intentioned, was excessive, separated patient and family, and ultimately disrupted the dying process. I have long wondered how this situation can be improved. I have concluded that physicians should periodically admit their limitations frankly, sadly, honestly even if such admission contradicts their training and challenges their identity as physicians. Of course not.
Physicians are invaluable to dying patients and their families.
But, by acknowledging limits on their medications and technical skills, physicians can focus on their other roles as healers and open themselves to far more meaningful and rewarding care. Every person wants to live well, and every person wants to die well. Physicians should therefore not ask people to choose between doing everything and doing nothing. Instead, physicians should ask people to discover what doing everything truly is. I therefore very much appreciate Dr. Knudsen's comments and any discussion on this topic that my essay has encouraged.