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End of life: what physicians say, in their own words

Last updated September 24, 2026.

The short answer

Read together, the 503 essays and podcast transcripts on this page say one thing consistently: doctors describe the end of life as the part of their work they were not trained for, and they name the same failures for twenty years. The conversation is avoided by physicians and waited for by patients. Hospice is used in the last days rather than the last months. Code status is decided in the emergency department at three in the morning. A directive on paper is not what happens in the room. Physicians disagree sharply about one thing, whether they should help a patient die, and the record holds both sides in equal measure. The essays that are most KevinMD’s own are the ones no journal would publish: a physician describing the patient who died, and what that patient taught them.

This page is a maintained record of what physicians have written about dying, hospice, palliative care, and the decisions at the end of life on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 503 essays and podcast transcripts with end of life, hospice, palliative, dying, DNR, code status, advance directive, or assisted dying in the title, published between September 2004 and September 2026 by 262 named contributors, 285 of the posts bylined by physicians, with the rest by nurses, chaplains, patients, and family members. Every claim on this page is attributed to a named author with the date it was published and a link to the original.

The sections below are organized around the questions patients, families, clinicians, legislators, and journalists ask. Each opens with a direct answer, followed by what named authors have said, in the order they said it. Where authors cite studies, the study is named alongside the author, and the figures are theirs. This is a page about physician opinion and experience, not clinical or legal guidance. Discussion of assisted dying on this page describes the law and the arguments, not methods.

This record at a glance

503posts

2004 to 2026years covered

262named contributors

47posts cited on this page

What do physicians say about telling a patient they are dying?

Physicians on KevinMD describe the prognosis conversation as the skill medicine teaches least and needs most. They cite the same evidence for two decades: most patients with incurable cancer believe treatment might cure them, oncologists pivot from prognosis to logistics, and families are asked to decide without ever having been told. The physicians who do it well describe holding two possibilities at once, hope and preparation, and say the conversation is a series rather than an event. Posts mentioning goals of care or the conversation rose from 3 percent before 2010 to about 30 percent since 2013.

Philippa Kennealy, MD, MPH, wrote in August 2010 that physicians avoid the subject partly because “the death of a patient represents failure,” and cited a 1997 study in which 30 percent of seriously ill hospital patients said they would rather die “than live permanently in a nursing home,” in “Doctors need to confront end of life care.” Jordan Grumet, MD, gave in January 2012 an account of telling a man he was dying, and in December 2012 that physicians suffer a blindness to prognostication, the innate ability to understand when a person is dying; both are short essays counted here but not indexed or linked. Barron H. Lerner, MD, an internist and historian of medicine, wrote in January 2012, reviewing Lisa Niemi’s account of Patrick Swayze’s final illness, that “The best doctors, I believe, help their gravely ill patients celebrate modest successes,” in “How Patrick Swayze died: Why we should care.” Robert Wachter, MD, wrote in November 2012 that a study found “Approximately half of the lung cancer patients and two-thirds of the colorectal cancer patients believed that a cure was” very or somewhat likely, when the chance was essentially nil, and that clinicians need better training in offering accurate information “without robbing patients and families of (realistic) hopes,” in “Prognosis near the end of life: We need better tools.”

Vincent DeGennaro, Jr., MD, MPH, wrote in August 2015 that patients in developing countries “rarely ask questions about how long they have to live or even if they’re going to die,” and make different choices from patients in the United States, in “Culture influences end of life decisions.” Don S. Dizon, MD, an oncologist, wrote in January 2016 of a patient who stayed on treatment for fifteen months “all the while being a mother to her daughter and a daughter to her own mother,” and of knowing the next conversation would be difficult, in “At the end of life, medicine truly becomes an art.” Gregory Jasani, MD, and Rebecca Rubenstein, MD, emergency physicians, wrote in April 2020, in the first weeks of the pandemic, asking families to discuss the what ifs, because “Many patients come to our emergency department too critically ill to tell us what their wishes are,” in “Emergency physicians want you to have the talk about end of life care.” Deepa Iyengar, MD, MPH, wrote in July 2021 that in Asian Indian families older parents “usually let children make decisions regarding their health,” and that cultural competence begins with understanding a family’s background when its wishes conflict with Western values, in “Culture and end-of-life caretaking.” Althea Halchuck, EJD, a patient advocate, wrote in April 2022 of a woman kept “on infusions for a useless Hail Mary treatment” for weeks, whose daughters said she should have been on hospice from the start, and who “died in the hospital with her family around her, but everyone had a bad death,” in “A bad death: the importance of truth-telling at end-of-life.” Sonny Miles, MD, a palliative care physician, wrote in July 2024 of asking patients to hold “two possibilities: leaning into treatment and the hope that time is long,” and also what they would want if it is not, in “How to live when you know you are dying.”

On The Podcast by KevinMD: “A bad death: the importance of truth-telling at end-of-life,” Althea Halchuck, June 2022.

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What do physicians say about hospice and palliative care, and why are they used late?

Physicians on KevinMD have said since 2011 that hospice is used in the last days rather than the months it is designed for, and they give the same reasons each time: patients and families hear it as giving up, physicians refer late because referring feels like failure, and the words “palliative” and “hospice” are confused with each other and with stopping care. Hospice appears in about half of posts since 2010; palliative care rose from 11 percent before 2010 to 45 to 48 percent since 2013. The physicians who work in the field write that it extends life as often as it shortens it, and, in the newest essay, that it is called for beds as often as for patients.

Jim deMaine, MD, a pulmonologist, wrote in November 2011 that hospice “tends to be underutilized with patients being referred there often only a few days before death,” in “We are seeing more terminal patients being referred to hospice.” James C. Salwitz, MD, an oncologist and the most frequent contributor on the topic, wrote in March 2012 of a patient who wanted to die at home surrounded by family and was instead misplaced in the system, and that “When I informed the family he was misplaced, they seemed distressed,” in “Let me end my life in peace, surrounded by family,” and in February 2013 on when a physician should obtain a palliative care consult, in “When should a physician obtain a palliative care consult?” Monica Williams-Murphy, MD, an emergency physician, wrote in September 2012 of a hospice patient sent to the emergency department for full treatment, asking whether “seeing her dead body, with tubes sticking out of every orifice,” would give her family peace, in “Doctors are practicing irrational medicine at the end of life.” In March 2015 she wrote that “almost 90 percent of Americans say” they want to spend their last days at home, and that hospice is a Medicare benefit for those in the last six months of life, in “3 myths and 3 truths about hospice.”

Jordan Grumet, MD, wrote in February 2017 that “If palliative care were a bus, hospice would be a few rows of seats in the front or back,” in “Palliative care is a team sport.” Debbie Moore-Black, RN, wrote in March 2017 that 20 percent of hospice patients are under 65, including children, and that hospice care is provided wherever the patient is, in “How hospice helped my mother find peace,” and in January 2018 of being ignored as a nurse and a wife during her husband’s final illness, in “My husband was dying. I was being ignored.” Kevin Haselhorst, MD, an emergency physician, asked in February 2018 whether physicians should be required to inform patients of their palliative care rights, including “the right to sleep in your own bed tonight,” in “Should doctors be required to inform patients of their palliative care rights?” Michael A. Salvatore, MD, a palliative care physician, wrote in February 2018 of a stat palliative consult requested only when a patient was hours from death, and that not knowing “that relieving the suffering of patients fulfills a physician’s humanity” is the ignorance behind such requests, in “A ‘stat’ palliative care consult: cognitive dissonance meets cognitive ignorance.” Shikha Jain, MD, wrote in May 2018 that coverage of Barbara Bush’s death describing her as foregoing further medical care “are not only inaccurate, they also minimize the incredible medical care provided by palliative care and hospice teams,” in “How Barbara Bush’s legacy can help us rediscover the benefits of palliative care and hospice.” Patricia M. Fogelman, DNP, wrote in July 2026 that the Medicare hospice per diem “has not kept pace with the actual cost of interdisciplinary care delivery,” and that facilities treat hospice referral as a discharge event, in “Why Medicare hospice coverage fails the dying.” Raya E. Kheirbek, MD, MPH, a palliative care physician, wrote in September 2026 of an ICU attending who told her “I called palliative care because I needed to free up the bed,” and that earlier consultation is associated with shorter stays and lower costs, “savings that come not from withholding care but from aligning it with what a patient actually wants,” in “Palliative care in the ICU: what the metrics never count.”

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What do physicians say about DNR orders, code status, and advance directives?

Physicians on KevinMD describe the code status decision as one made too late, too fast, and too often by the wrong person, and the advance directive as a document that is ignored, misread, or absent when needed. Since 2018 the record includes physicians and attorneys describing directives misinterpreted in both directions, patients resuscitated against their orders and patients treated as DNR because they had a living will. Posts mentioning DNR or code status have held between 10 and 19 percent across the record; posts mentioning advance directives peaked at 24 percent in 2010 to 2012 and again since 2023.

Kevin Pho, MD, wrote in October 2006 that long-term survival after in-hospital CPR is about 15 percent in some studies while a 1996 New England Journal of Medicine article found the survival rate on television medical dramas was 67 percent; the post is a short commentary from before 2009, counted here but not indexed or linked. James C. Salwitz, MD, wrote in January 2013 that a DNR “for obvious reasons needs to be made ahead of time,” and that a patient can ask for everything and add “if it fails I do not want to end my life on a machine,” in “When is making the decision to be DNR appropriate?” Brian J. Secemsky, MD, wrote in April 2013 that code status describes what intervention, if any, a team will conduct “should their patient’s heart stop beating or lungs stop moving air,” in “5 essential concepts to know about code status.” Monica Williams-Murphy, MD, wrote in November 2015 of a dying man with a DNR sent from a nursing home for a full treatment because the order had reportedly been revoked, that “I stood angrily in the hallway, posed in my white coat with hands on hips,” and of being the only advocate in the room, in “I may be the only advocate for my dying patient.”

Skeptical Scalpel, MD, wrote in December 2018 of a patient with a lawfully executed DNR and a purple DNR bracelet who was resuscitated anyway and sued, and that “she was successfully resuscitated and now faces continued pain and medical bills,” in “A patient sues when a DNR is ignored.” Teddy A. Teddy, MD, wrote in July 2026 that a patient “may be full code in the emergency department, changed to DNR on admission, reverted to full code” after a family conversation and later returned to DNR, and that a code team acting on an outdated order faces liability either way, in “When a DNR order becomes a legal liability.” Ferdinando Mirarchi, DO, and Thaddeus Mason Pope, JD, PhD, wrote in July 2026 that clinicians “treat patients who want resuscitation as though they are DNR just because they have an AD,” a safety risk the TRIAD studies have documented, in “Why problems with advance directives keep harming patients.”

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Should physicians help patients die? Physicians disagree.

Medical aid in dying, called physician-assisted suicide by its opponents and death with dignity by its supporters, is the one question on this page where physicians on KevinMD divide rather than converge, and they have since Oregon’s law in 1997. Supporters write that the practice is rare, used almost entirely by hospice patients, and distinct from suicide. Opponents write that safeguards fail, that prescribing relationships are brief, and that the option diverts attention from palliative care. The record includes physicians who are themselves terminally ill on both sides. Posts on the subject rose from 3 percent before 2010 to 17 percent since 2023.

Peter Ubel, MD, wrote in September 2013 that physician-assisted suicide “can be part of a dignified death,” while asking how many patients “unnecessarily suffered at the end of life because the death with dignity law misdirected their attention from palliative care,” in “Don’t confuse death with dignity with suicide.” Jim deMaine, MD, wrote in November 2014, after the death of Brittany Maynard under Oregon’s law, that “with good palliative and hospice care, death with dignity is relatively rare even in the states where it is legal,” in “Brittany Maynard: It’s more than death with dignity.” Christopher Stookey, MD, wrote in October 2015, after his father died in home hospice following a stroke, that “I wish doctor-assisted death had been available to my father,” in “Terminal dehydration: A gentle way to die?” Kevin Tolliver, MD, MBA, wrote in May 2019 that the palliative care organizations’ position is that society should improve hospice and palliative access, “On the other hand, there are many advocacy groups in favor of right-to-die,” in “The nuances between palliative care vs. physician-assisted suicide.” Ton La, Jr., MD, JD, wrote in November 2019 that where it is legal the practice “is ultimately a joint and collaborative process; it involves a decision between the competent patient, family, and physicians,” in “Physician-assisted suicide is a collaborative process.”

Roger Kligler, MD, a physician with terminal cancer, wrote in October 2020 that the practice was legal in nine states and Washington, D.C., “which collectively represent 22 percent of our nation’s population,” that more than 90 percent of Oregon patients who use it are in hospice, and that the Journal of Palliative Medicine had published clinical criteria for it as physician aid in dying, not assisted suicide, in “Medical aid in dying is not assisted suicide.” Joseph E. Marine, MD, MBA, wrote in March 2024 that in Oregon in 2021 and 2022 “the median duration of the patient relationship with the physician prescribing assisted suicide was only five weeks,” and that in the 80 percent of cases with no medical witness “they have no way to know if complications occurred,” in “Assisted suicide is the wrong prescription.”

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What do physicians say the death of a patient taught them?

The essays that belong to KevinMD alone are the ones in which a physician describes a patient who died. They span every stage of a career, the student at a first death, the resident at three in the morning, the oncologist after fifteen months, and they converge on the same lesson written in different words: that detachment was taught and did not serve, and that being present was the treatment. Posts describing a first death or written by students and residents rose from 5 percent before 2010 to 33 to 40 percent since 2016.

Joanne Wolfe, MD, MPH, a pediatric oncologist and palliative care physician, wrote in July 2015 that during the first six months of a child’s cancer treatment “30 percent of families experience food, energy or housing insecurity,” and that pediatric palliative care must work with the primary care pediatricians who know the family, in “Pediatric palliative care: We must do more.” Earl Stewart, Jr., MD, wrote in September 2015 that “Caring for the dying patient is as much a challenge as it is rewarding,” in “Caring for the dying patient is a rewarding challenge.” Jalal Baig, MD, an oncologist, wrote in February 2017 that he got through residency “largely free of questions about medicine’s limitations,” and that only when he understood them could he help a family “pursue an end of dignity and comfort,” in “What this physician learned from a dying patient.” An anonymous night-shift clinician wrote in April 2018 of a patient who, once her family had left for the night, “finally broke down in front of me and began to say everything that was on her mind,” in “A silent moment with a dying patient.”

Jessica Bloom, MD, wrote in March 2024 of her father’s death after “conversations for at least 30 years prior about his eventual death,” and of watching his physicians’ “eyes and their bodies as they talked to us,” in “From doctor to family: Witnessing both sides of end-of-life care.” Dr. Damane Zehra wrote in June 2025 of being called to the ICU for “a young male who had been admitted a few days earlier with severe respiratory distress,” and what his handshake taught her, in “What a dying patient’s handshake taught me about life and love.” Aditya Singh, MD, wrote in June 2026 that “Over the years, I learned to do what we are all taught to do: Compartmentalize,” and that holding a dying patient’s hand “wasn’t about carrying a burden; it was about witnessing and facing the truth,” in “Detachment is not strength: lessons from dying patients.”

On The Podcast by KevinMD: “What being a hospice volunteer taught me about health care,” Farid Alsabeh, January 2023; and “How a dying patient taught a doctor the meaning of care,” Augusta Uwah, October 2025.

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What do physicians say about the cost of care at the end of life?

Physicians on KevinMD have written about end-of-life spending since 2009, the “death panels” year, and their argument has stayed steady: a large share of Medicare spending falls in the last months of life, much of it on care patients would not choose if asked, and the fix is the conversation, not rationing. A minority argue that human nature defeats the savings, and one recent essay argues the overtreatment is a spiritual problem rather than a financial one. Posts mentioning cost or Medicare peaked at 39 percent in 2010 to 2012 and stand at 29 percent since 2023; “death panels” appeared in 14 percent of posts in those years and in 1 percent since.

Kevin Pho, MD, wrote in September 2009 that “While physicians must not hasten death, we should not provide futile care,” in “What does Tiger Woods have to do with medical futility and end-of-life care?” Naomi Freundlich wrote in May 2011 that after “the ridiculous fear-mongering about ‘death panels,'” Congress dropped end-of-life planning from the health reform law, and that an Archives of Internal Medicine report projected $77 million in savings if half of the cancer patients who died in 2008 had held end-of-life discussions, in “The government reversal on end of life planning.” Steven Reznick, MD, wrote in April 2013 that living wills, directives, and hospice “will not put a dent in these costs because of human nature,” in “Human nature prevents any cost savings at the end of the life.” Taylor J. Christensen, MD, wrote in January 2021 of a patient kept in the hospital two extra days so his daughter could visit, and that “I am left judging whether $4,000 of society’s money is worth spending on this brief visit,” in “A real-life example of irrational health care spending.” Anthony Grandelis, MD, an OB/GYN hospitalist, wrote in September 2026 that overtreatment at the end of life “is, at its core, a spiritual problem dressed in clinical language,” and that providers who keep trying at the system’s request accumulate “the wound of knowing what is right and being unable to do it,” in “Overtreatment at the end of life is a spiritual problem.”

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How has the end-of-life conversation changed since 2004?

The corpus shows the subject arriving with the physicians who made it their specialty. Before 2010 the posts were few, mostly Kevin Pho’s, and about CPR survival, futility, and the 2009 “death panels” fight. From 2010 to 2015 KevinMD published 22 to 44 posts a year on the subject as Grumet, Salwitz, Williams-Murphy, deMaine, and Haselhorst wrote it from inside hospice and palliative care, and the Brittany Maynard case in 2014 opened the assisted-dying argument. Since 2016 the volume has settled near 20 a year and the subject has widened: students and residents describing first deaths, the pandemic in 2020, grief in a fifth of posts, and, since 2023, advance directives failing in both directions and assisted dying argued more often than at any point in the record.

Term 2004 to 2009 (69 posts) 2010 to 2012 (90 posts) 2013 to 2015 (117 posts) 2016 to 2019 (88 posts) 2020 to 2022 (58 posts) 2023 to 2026 (81 posts)
Hospice 20 percent 54 percent 52 percent 48 percent 33 percent 40 percent
Palliative care 11 percent 39 percent 48 percent 47 percent 48 percent 45 percent
The conversation or goals of care 3 percent 25 percent 36 percent 28 percent 28 percent 30 percent
DNR or code status 12 percent 10 percent 19 percent 14 percent 14 percent 18 percent
Advance directive or POLST 2 percent 24 percent 19 percent 14 percent 12 percent 24 percent
Assisted dying 3 percent 6 percent 12 percent 12 percent 7 percent 17 percent
Cost or Medicare 24 percent 39 percent 31 percent 27 percent 17 percent 29 percent
Death panels 2 percent 14 percent 8 percent 2 percent 0 percent 1 percent
First death, students, or residents 5 percent 24 percent 28 percent 40 percent 31 percent 33 percent
Grief 2 percent 11 percent 10 percent 14 percent 12 percent 21 percent
Chaplain, spiritual, or faith 3 percent 23 percent 16 percent 23 percent 16 percent 26 percent
COVID 3 percent 0 percent 0 percent 1 percent 38 percent 11 percent
AI 0 percent 0 percent 0 percent 0 percent 2 percent 17 percent

Term frequencies were computed on the September 5, 2026 corpus of 508 posts; the corpus has since changed by a handful of posts, which does not move the percentages.

Kevin Pho’s posts open the record: CPR survival on television against the studies in October 2006, futility in September 2009, and, in November 2009, five questions to start the conversation at a family holiday; the first and last are short commentaries, counted here but not linked. Kennealy, in 2010, asked why physicians treat a patient’s death as failure. The 2011 to 2013 posts are the specialty writing itself in: deMaine on late referral, Grumet telling a man he was dying, Salwitz on peace and on DNR timing, Williams-Murphy on irrational medicine, Wachter on prognosis, Secemsky decoding code status, and Reznick and Freundlich on cost. Ubel opened the assisted-dying argument in 2013 and deMaine answered Brittany Maynard in 2014. Dizon in 2016, Baig in 2017, and the anonymous night-shift essay in 2018 are the patient-death genre at its strongest; Jasani and Rubenstein’s pandemic appeal is 2020; Kligler and Marine argue aid in dying from opposite sides in 2020 and 2024; and the 2026 posts, Teddy, Mirarchi and Pope, Singh, Fogelman, Grandelis, and Kheirbek, are about orders, directives, detachment, the Medicare benefit, and what the ICU calls palliative care for.

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About this record

The KevinMD end-of-life corpus by the numbers

The figures below describe the set of KevinMD posts this page draws on, as of September 18, 2026. They are counts of what KevinMD has published, not survey data.

Measure Value
Posts in the corpus 503
Date range September 20, 2004 to September 14, 2026
Named contributors 262
Posts bylined by an MD or DO 285
Posts by nurses, chaplains, patients, family members, and other non-physicians About 100
Posts on assisted dying, by any of its names About 30
Short posts by Kevin Pho, 2004 to 2011 83, median 97 words
Podcast episodes with full transcripts 30
Posts in the corpus that are not indexed, counted but not cited 95
Total words About 370,000
Peak years 2013, 44 posts; 2012, 39 posts
Most frequent contributors James C. Salwitz, MD (21); Monica Williams-Murphy, MD (14); Jordan Grumet, MD (13); Kevin Haselhorst, MD (11); Jim deMaine, MD (10); Don S. Dizon, MD (7)

How this page was built and how it is updated

The corpus was assembled from title searches for end of life, hospice, palliative, dying, DNR, code status, advance directive, advance care planning, death with dignity, physician-assisted, medical aid in dying, assisted suicide, and assisted dying, with false matches for “dying” and “life” removed. Term frequencies were computed against the full text of each post on the corpus assembled for the September 18, 2026 build; this page was converted to the current standard on September 20, 2026 without rebuilding that corpus, so the counts and figures are as of September 18, 2026. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. Ninety-five posts in the corpus are not indexed: Kevin Pho’s 2004 to 2011 commentaries, a dozen short essays, and 16 podcast episodes without transcripts. They are counted but not cited. Quotations are taken verbatim from the original posts; the assisted-dying section describes the law and the arguments and reproduces nothing about methods. Author credentials are as they appeared in the byline at publication. Kevin Pho’s posts from 2004 to 2011 were short commentaries on news and are counted separately above. James C. Salwitz, MD, the most frequent contributor, is cited at the same rate as other frequent voices rather than in proportion to his output. On September 24, 2026, two posts were added to answer questions readers bring to this subject; they were read in full and checked against the same rules, and the counts above were not recomputed. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. The closest archive is the Palliative Care tag. Related records: Opioids: what physicians and pain patients say, in their own words, Medical malpractice: what physicians say, in their own words, Nursing: what nurses and physicians say, in their own words, and Residency: what residents and attendings say, in their own words.

This page is updated as new end-of-life essays are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. End of life: what physicians say, in their own words. KevinMD.com. Updated September 24, 2026. https://kevinmd.com/end-of-life

The 47 KevinMD posts cited on this page, in order of publication

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