As a physician, I have been at the end of many lives and have witnessed the profound anguish that families endure in the final moments of a loved one. While most family members express deep gratitude for the care provided by doctors and nurses, some tell harrowing stories of unnecessary pain their loved ones endured in their final days. These harrowing accounts highlight a disturbing ambiguity in the care we provide, blurring the line between compassionate treatment and what can feel like unbearable torture.

Motivated by my encounters with grieving families, I dedicated the ninth season of Fixing the healthcare system Podcast to explore the final chapter of life and address the shortcomings in end-of-life care. The eight experts who joined me this season have fundamentally changed the way I view life and death. Here are nine important lessons from this season that I hope will resonate with you and provide guidance and comfort as you journey toward the peak of life.

1. “People have goals other than living longer.”

In the bestseller Being mortalRenowned surgeon and author Dr. Atul Gawande tells the story of his father’s death from cancer and the difficult medical decisions his family had to make. In our recent conversation, he stressed the importance of drawing a line between a life worth living and one that has lost all meaning.

“(My father’s oncologist) could recommend eight different chemotherapy regimens and knew the pros and cons of each one. For us, the question was, ‘What happens if we don’t choose one?'”

Doctors struggle to accept the limitations of medical interventions and often overlook patients’ personal goals. Gawande urges doctors to ask patients: (a) “What is most important to you?” and (b) “What are you not willing to give up, even if it means shortening your life?”

2. “The last day of your life is not the sum of your life.”

Dr. Lucy Kalanithi, widow of Paul Kalanithi, author When breath becomes airunderstands the pain of losing a loved one. Her husband’s memoir details his battle with advanced lung cancer, and her advice reflects the valuable lessons they learned together.

Lucy shared with me her concern that aggressive medical interventions would cause Paul unnecessary pain and suffering in his final days, and she feared that efforts to prolong his life would come at the expense of his dignity and tarnish her memories of him.

Paul gently reassured them: “The last day is just a day.” His words encourage relatives to focus on a person’s life as a whole and not on its end.

For families struggling with regret, medical trauma or unspoken words, Lucy offers comfort: “You did your best and that’s all anyone can ask for.”

3. “We are sexual beings throughout our lives.”

Dr. Pebble Kranz, a specialist in sexual medicine, refutes the common misconception that sexuality must decline with death. During our conversation, she emphasized that sexual desire remains a central part of human identity and persists even into the final stages of life.

Dr. Kranz advocates for open, compassionate dialogues between patients and doctors: “Doctors talk to patients about poop, we talk about mental illness and all kinds of very personal things. Why should sex be considered this one area that is too personal?”

She reminds us that terminally ill people have the right to pursue what brings them joy and fulfillment, just like everyone else. According to Dr. Kranz, respecting our full humanity, including our sexual identities, helps preserve the meaning of life as it nears its end.

4. “The time to see a palliative care doctor is not when you die, but before.”

Dr. Monique Schaulis, an emergency medicine doctor, emphasizes that her specialty – palliative care – is not just for end-of-life care. Rather, it must be integrated into medical care at every stage of serious illness in order to improve people’s quality of life.

“Palliative care is transdisciplinary and holistic, focusing on patients from diagnosis to the end of life,” she emphasized during our interview. It addresses physical, psychosocial, spiritual and existential distress and helps patients and families deal with complex emotions and decisions.

Importantly, Dr. Schaulis explains that hospice care is just one component of palliative care and does not mean giving up on the patient or their family. Rather, it is about making patients stronger, better nourished and pain-free. This approach usually leads to longer, more fulfilling lives compared to traditional treatments.

Former President Jimmy Carter is an inspiring example: he spent over a year in hospice and has enjoyed a more fulfilling life since participating in the program.

5. “No one should have to suffer.”

In a very personal episode, New York Times columnist Steven Petrow told the story of his sister Julie, who chose Medical Aid in Dying (MAID) after being diagnosed with terminal ovarian cancer.

Petrov was initially skeptical about MAID, but when she witnessed Julie’s suffering, her view changed.

“I had no doubt at all that this was a necessary measure,” said Petrov, grateful that his sister’s life ended in peace. “If people do not have this opportunity, there will be unnecessary suffering and painful deaths.”

For patients like Julie, the ability to control their destiny – to choose how and when their suffering is alleviated – can make life more bearable. Often, just knowing that they have that control can give them the strength to prolong their lives. Julie’s story underscores the importance of maintaining personal agency and making informed decisions about one’s own medical care.

6. “Spiritual care is an essential component of compassionate medicine.”

In her role as a chaplain, Rabbi Melanie Aron has cared for hundreds of hospital patients of various faiths, emphasizing how spirituality and community can provide comfort to patients.

“Religious leaders are grappling with how best to support people in a rapidly evolving health care world and provide them with a sense of peace and purpose,” she said. “Spiritual support can ease emotional pain and suffering and help people grapple with end-of-life issues.”

She stresses that it is important for doctors to consider the moral and ethical aspects of dying in addition to the medical ones. She has observed that when medical professionals integrate spiritual care into their medical practice, they contribute to emotional healing and comfort in people’s final days.

7. “We should not save a life at any cost.”

Dorothee Caminiti, a bioethicist at Santa Clara University, is interested in the ethical dilemmas surrounding life-saving interventions. In our conversation, she questions the principle of saving a life at all costs.

“We can extend life forever,” she said. “We have to decide whether that makes sense.”

Balancing patients’ rights, doctors’ insights and families’ wishes is a complex challenge. Caminiti emphasized the critical role of advance directives, which ensure a patient’s wishes are known and respected when they cannot speak for themselves. She stressed, “The best way to ensure your health care wishes are respected is to document them clearly before a crisis occurs.”

8. “Good relationships lead to health and happiness.”

In our final episode of the season, author and public health expert Brad Stulberg reflects on his recent New York Times Column “The key to longevity is boredom.”

In our interview, which airs on August 27, he emphasizes that regular exercise, eating a nutritious diet, not smoking, limiting alcohol consumption and maintaining meaningful relationships are the keys to a long and healthy life.

Boring? Yes, especially compared to the hype surrounding various nutritional supplements and treatments with no evidence. But Stulberg pointed to research showing that people who do these five things live seven years longer and spend six of those years in good health.

His findings remind us that frailty does not necessarily determine how we age. Investing in our health early in life can make the end of our lives more positive.

9. “Be optimistic at the end of your life.”

Reflecting on the guests on this season of the Fixing Healthcare podcast, I have gained a more optimistic outlook on the final stages of life. Each of these eight experts has convinced me that we can positively improve people’s end-of-life experiences and preserve human dignity in these tender moments.

Palliative care can empower patients, hospice can ease suffering, and intimacy can continue to flourish. Healthy habits can sustain our vitality, and spirituality can help us find peace and acceptance as we face life’s final chapter. And finally, the love we have cherished throughout our lives can provide comfort and support until our final breath.

While none of us enjoy saying goodbye, it is comforting to know that the end of life can be a meaningful, connected and peaceful experience – much better than today.

Please tune in on September 3, 2024 for the first episode of Season 10. This time on the Fixing Healthcare podcast, we speak with experts in medical and AI technologies. This season begins with a familiar voice: returning guest and author of “Deep Medicine,” Dr. Eric Topol.