Im not afraid of dying, she said, smiling at me. I feel like Im on a runway, about to take off. Her words, spoken with such clarity by a woman facing two advanced cancers, have stayed with me. As a palliative care physician, I wish more patients felt empowered to face their mortality with such openness. But the truth is, we, as a society and a medical community, have made it incredibly difficult to have honest conversations about death.

A Whisper, a Shame, an Error

This avoidance was brought into sharp focus by a recent NYT opinion essay entitled “If My Dying Daughter Could Face Her Mortality, Why Couldn’t the Rest of Us?”. Sarah Wildman, a mother who lost her daughter to cancer, wrote: “Death in America is a whisper, a shame, an error.”

She’s right. We’ve become so fixated on fighting death, on finding the next cure, the next clinical trial, that we’ve forgotten how to acknowledge its inevitability.

The Modern Death Paradox

Here’s the paradox: even with tools that seemingly provide more clarity, talking about dying remains incredibly difficult. AI can now predict survival with increasing accuracy, giving us a seemingly clearer picture of the future.1 Genetic testing reveals a multitude of possibilities, and there’s always another clinical trial, another potential breakthrough on the horizon. You’d think this abundance of information would make conversations about death more straightforward.

But it doesn’t.

In fact, this abundance of what-ifs data can become another barrier. Each new piece of information, each new possibility, can be used to deflect and avoid acknowledging the ultimate reality. It becomes another reason to postpone the difficult conversation and cling to hope, even when the odds are slim. We are drowning in data, yet acknowledging the limits of treatment and the inevitability of death remains a significant challenge.

The Price of Silence

By shielding patients from the truth, we rob them of the chance to make informed choices to prioritize what truly matters in the time they have left. The bill for this avoidance inevitably comes due, often in a chaotic ICU setting, leaving everyone unprepared and distressed.

Unexpected Lessons

Interestingly, programs for medical assistance in dying (MAID), where legal, offer an unexpected insight (read here about a recent experience in Canada). Regardless of one’s stance on MAID, these programs require a level of directness and repeated conversations about end-of-life choices that we rarely see in standard medical practice. This demonstrates that patients are often more able to discuss these issues than we give them credit for.

A Call to Action: Truth-Telling in Medicine

My plea to fellow clinicians: let’s try telling the truth. Not because it’s easy, but because our patients deserve it. They deserve the chance to live fully, even in the face of death.

To everyone reading this, I ask: When was the last time you had an honest conversation about death? With your loved ones? With your doctor? It’s time to start talking.

Facing Mortality with Courage and Compassion

Death isn’t a medical failure. It’s the one certainty we all share. Let’s face it with courage, compassion, and honesty.