We all must die of something. That is a biological certainty. Yet the medical profession often behaves as though death itself were the enemy, rather than the suffering that precedes it. In elderly patients, especially those over 70, the pursuit of cures can become a pursuit of futility.
Consider the paradox: dementia is feared for its slow erosion of identity, yet the diseases that might end life before dementia—heart failure, cancer, pneumonia—are treated as adversaries to be vanquished at all costs. The result? Patients live long enough to lose themselves.
Gawande (2014) observed, “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is… to enable well-being.” That well-being may sometimes mean allowing nature to take its course.
Yet this ethos is rarely taught. Medical training emphasizes intervention, not restraint. The Hippocratic oath is interpreted as a mandate to preserve life, even when that life is no longer livable. As Callahan (2000) argued, “The goal of medicine should not be to defeat death, but to help people die well.”
There is a cultural discomfort with this idea. Death is framed as failure, and physicians are conditioned to fight it. But in the elderly, the calculus must shift. Aggressive treatment may extend biological existence while diminishing quality of life.
In truth, the most humane medicine may be the one that knows when to stop. As philosopher Daniel Callahan put it, “Medicine must learn to say no—not to life, but to the illusion that life can be endlessly prolonged” (Callahan, 2000).
We must rethink our metrics. Success should not be measured in months added, but in suffering avoided. For patients in their final years, the question is not “Can we cure?” but “Should we?” And sometimes, the answer is no.