Epilogue

Being mortal is about the struggle to cope with the

constraintsofourbiology,withthelimitsset bygenes
andcellsandfleshandbone.Medicalsciencehasgiven
usremarkablepowertopushagainsttheselimits,andthe
potential value of this power was a central reason I
becameadoctor.Butagain andagain,Ihaveseenthe
damageweinmedicinedowhenwefailtoacknowledge
that such power is finite and always will be.

We’vebeenwrongaboutwhatourjobisinmedicine.We
thinkourjobistoensurehealthandsurvival.Butreallyit
is larger than that. It is to enable well-being. And
well-beingisaboutthereasonsonewishestobe alive.
Thosereasonsmatternotjustattheendoflife,orwhen
debilitycomes,butallalongtheway.Wheneverserious
sicknessorinjurystrikesandyourbodyormindbreaks
down, the vital questions are the same: What is your
understandingofthesituationanditspotentialoutcomes?
Whatareyourfearsandwhatareyourhopes?Whatare
thetrade-offsyouarewillingtomakeandnotwillingto
make?Andwhatisthecourseofactionthatbestserves
this understanding?

Thefieldofpalliativecareemergedoverrecentdecades
tobringthiskindofthinkingtothecareofdyingpatients.
And the specialty is advancing, bringing the same
approachtootherseriouslyillpatients,whetherdyingor
not.Thisiscauseforencouragement.Butitisnotcause
for celebration. That will be warranted only when all
cliniciansapplysuchthinkingtoeverypersontheytouch.
No separate specialty required.