REFLECTIONS ON DEATH AND DYING

Americans simultaneously worry about drying and about being tethered t o machines that keep them alive beyond a point when life has any meani ng. People living with terminal illness often feel isolated from life around them and a burden on those they love; they feel uncertain that their deaths will be relatively free of pain and suffering and that th eir dignity mill De compromised as little as possible. These failings cart be remedied. Traditional hospice care and integrating palliative care into the general medical setting are important, but they cannot a lone occasion a better dying. The medical community must re-imagine dy ing and reflect about ways to transform image into reality in practice and in training colleagues acid successors, Physicians and others kno w how to provide care and even improve living when cure is unlikely; t he harder task is to respect such care as profoundly as curing. The ex igencies of modern medicine, where time is a budgetable commodity, mak es caring well for dying patients difficult, Medicine cannot have hege mony over dying and cannot singularly offer people a better death, but it cannot absent itself either. The almost single-minded focus on dec ision making that has infused conversations about dying and death may divert attention from the attentiveness and loving relationships that are as vital at lite's end as at its beginning. Medicine has ''coloniz ed'' death: It has transformed it into a place where progress in stavi ng it off may appear to be unlimited, and thus it encourages forgettin g that death is part of the human condition. The task before medicine, and academic medicine in particular, is to transform death into a hum an scale. With that is available to delay death-but not to make it opt ional-the most important task is to recover humbleness before an aweso me moment and be with the patient, one human being to another, knowing that dying is not always open to solutions.