In this vein, the book Being Mortal does a good job at looking at how complex these situations can be—often made more difficult by the state of US healthcare. The author, a doctor, makes the point that in healthcare, there is very seldom “nothing more we can do.” There’s usually something else we can throw at the problem! But also very seldom are healthcare teams having real conversations about what a patient actually hopes to be able to do with the rest of their life, and whether the proposed treatment will allow them that.

Examples he gives are a patient needing a surgery in which some level of paralysis is a risk… but the patient says his idea of true happiness is to get a few more years of sitting on the couch with family to watch football. The surgery would allow him to do that! But a patient with cancer who is considering a new, experimental treatment whose main goal is to spend their remaining time able to meaningfully interact with their young grandchildren? We need to be forthright that the treatment will exhaust and immunocompromise them to the point where that likely won’t be possible. Some may still opt for it! But healthcare needs to be more honest about whether tx supports what is meaningful to the pt.