First of all, prolonging and supporting patients’ health and life is the entire reason for taking care of them in the first place. With the limited exception of medical providers who specialize in palliative care, we strive for our patients to recover, to leave our practices and clinics cured, or (failing that) well enough to have a baseline quality of life that justifies our being involved in their care in the first place. Letting go of this cardinal goal can be immensely difficult. If we can’t make people better, then what exactly is it that we’re accomplishing?

Further, there is always the fear of being accused of not doing all we could. The more we treat a patient, the less ambiguous our attempts to give them the best care possible. What better defense can there be against the threat of legal action than a full-court press at the very end? Though it’s a difficult factor to quantify, I suspect this kind of rationale undergirds a lot more of the aggressive end-of-life care that patients receive than many medical providers would care to acknowledge.

There seems to be little space for any kind of nuanced or challenging conversation along these lines in our society at this time.