In this highly personal and heartfelt article titled “Letting Go,” Atul Gawande expresses with compassion the conflict that many physicians feel in dealing with patients nearing the end of their life.

On the one hand, the work of the doctor is to keep people alive. But it is a job that ultimately, in every case, will end in failure. Knowing that, at what point should a physician advise their dying patient to seek comfort, rather than continuing treatments with painful side effects that may not extend their lifespan. In other words, is it within the role of the doctor to advise a patient to call it quits and go home to die?

As Gawande says: “The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.”

There is an growing awareness that the real need of a dying patient is not one more experimental treatment in the hope of “saving their life,” but rather the opportunity to make peace with their life, peace with family and friends, and if possible, peace with their impending death.

Gawande speaks with the voice of experience, the voice of one who has been on the front lines of life and death battles in the medical world. His story is authentic, and raises questions that we each need to answer for ourselves.

Click here to read the New Yorker article by Atul Gawande: “Letting Go”