Palliative Care

Demedicalize dying: Why end-of-life care needs a spiritual reset

Physician
February 6, 2026

If life is what we make it, then the end of life can be understood as a spiritual journey rather than a medical pursuit. We demedicalize dying by distancing ourselves from practices that use hope as consent (prolonging life through reflexive hospitalizations, procedures, or antibiotics that offer little dignity to those already living with serious illness).

Every medical decision poses a fundamental question: Is this the beginning of the end, or …

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End-of-life care cost substance use: When compassion meets economic reality

Physician
February 4, 2026

At two o’clock in the morning, the emergency department doors open to a familiar story. A middle-aged man arrives with massive gastrointestinal bleeding, severe jaundice, and advanced cirrhosis from decades of alcohol use. He has no insurance, no primary care provider, no stable home, and no ongoing addiction treatment. The next 10 days bring mechanical ventilation, endoscopic procedures, dialysis, and intensive care. The total bill will exceed $100,000, nearly all …

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Why every physician needs a sabbatical (and how to take one)

Physician
January 16, 2026

In the first episode of The Pitt season 2, Dr. Robby reveals he’s taking a three-month sabbatical, his last shift before heading to a UNESCO World Heritage Site in Canada. For a primetime medical drama to feature a physician stepping away for three months signals something important: Sabbaticals are entering the cultural conversation about how doctors survive in modern medicine.

But here’s what the show doesn’t tell you: Most physicians can’t …

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What is palliative medicine and why is it so misunderstood?

Conditions
January 16, 2026

After years of leading palliative medicine departments, as a Fellow of the American Academy of Hospice and Palliative Medicine, I’ve had countless conversations that start the same way. A colleague in the hallway says, “Oh, palliative care—that’s so important. You all are so nice.” Or a hospital administrator tells me, “We wish we could give you more, but resources are tight right now.” Or my personal favorite: “Palliative care is …

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Physicians’ end-of-life choices: a surprising study

Conditions
January 3, 2026

In July, I wrote about the importance of end-of-life planning (EOL). Shortly after, I read a study that examined physicians’ EOL plans with advanced cancer and Alzheimer’s disease (stage unspecified). The study encompassed nations with different forms of aid in dying, from the U.S., where a terminal coma is the only option most states allow, to Belgium, where physician-assisted dying (PAD) and euthanasia are available. Although the term suicide …

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How end-of-life planning can be a gift

Conditions
December 25, 2025

This is a work of fiction.

I directed Mrs. Powell to sit and make herself comfortable. She lowered herself into the chair at the round table in the lobby of my office slowly, her frail, 90-year-old frame eventually settling into it.

“How’s your health, Mrs. Powell?” I asked. This is how I approached most conversations in which a client asked if they could meet suddenly. Usually, it meant they had gotten some …

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A doctor’s ritual: Reading obituaries

Physician
December 5, 2025

I live across the street from a funeral home. Each day as I see the cars begin to line up and the people in dark clothes gather to say goodbye, I can’t help but wonder about the stories inside. Who were they coming to honor? What kind of life had just ended? So, most mornings, before I check my email or the hospital census, I read the obituaries.

As a child, …

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The role of meaning in modern medicine

Physician
November 17, 2025

For the past century, physicians have practiced within the framework of materialism: the belief that everything real can be measured, and everything measurable is real. But that worldview has been quietly eroded by physics itself. In the double-slit experiment, particles behave as waves of probability until observed, at which point they collapse into definite form. Later variations (such as Wheeler’s delayed-choice experiments) demonstrated that observation seems to determine not only …

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Advance directives not honored: a wife’s story

Conditions
November 14, 2025

For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an advance directive. And he did: It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.

But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, …

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Reclaiming physician agency in a broken system

Physician
November 14, 2025

“Health-care professionals are increasingly demoralised by pressure to prioritise their employers’ financial goals over patients’ needs and professional norms, as space for good work in a bad system narrows.” This statement from an October 2025 Lancet article spoke directly to my experience.

By all quantifiable metrics, I was successful. I’d just been promoted to associate professor in the number-one-ranked department in the country for my specialty. I had a rewarding leadership …

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The human cost of health care automation

Physician
November 8, 2025

AI is rolling out in medicine faster than most of us can process. Ambient scribes documenting visits. Clinical decision support algorithms. Automated prior authorizations. The promises are compelling: reduced clerical burden, more face-time with patients, less burnout.

I wanted this. As a palliative care doctor and director of physician well-being at my institution, I’ve spent years watching colleagues drown in documentation and burn out from relentless task loads. When AI tools …

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How to prepare for your death [PODCAST]

Podcast
October 31, 2025
YouTube video

Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Physician executive Joseph Pepe discusses his article, “A doctor’s guide to preparing for your death.” He shares practical and compassionate advice on planning for life’s inevitable end, from organizing essential documents and …

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Who wants to live to be a hundred?

Conditions
October 29, 2025

Extreme longevity

People claim they want to live to be 100, yet is that a good thing? How you get there may make all the difference. Here’s my take on Blue Zones and the prospect of living to 100. “Blue Zone” is a nonscientific term popularized twenty years ago by Dan Buettner, a National Geographic explorer who studied five geographic regions where many people live to be over ninety or 100. …

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A doctor’s guide to preparing for your death

Physician
September 15, 2025

Let us get this straight: Enjoying life is amazing. You should do more of it. Every day, if you can. But if you are truly committed to living well, you also need to get comfortable with something most people avoid like mystery meat at a buffet: preparing for your death.

Not obsessing over it. Not fearing it. Just preparing, so your loved ones are not left trying to solve your digital, …

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Why palliative care is more than just end-of-life support

Conditions
September 1, 2025

As doctors, we often tend to focus on solving the problem at hand. We identify the issue, make a diagnosis, and try to treat the condition to the best of our capabilities. And in this pursuit to achieve our textbook level of homeostasis, we often forget that it is the patient who requires us. As rightfully pointed out in the posters outside the palliative care center, sometimes we may encounter …

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The quiet work of dying: a hospice nurse’s reflection

Conditions
August 21, 2025

The first thing I remember is the sound of oxygen at night.

It was my second week as a hospice nurse. I had just pulled up to a modest home on a cul-de-sac, the kind of place where wind chimes echo off empty sidewalks. Inside, a man in his seventies was dying of end-stage pulmonary fibrosis. He was surrounded by family, but it was that soft hiss—steady and rhythmic, like an …

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Why medicalizing death could strip it of meaning

Physician
August 8, 2025

We’ve medicalized nearly everything in life—birth, aging, sleep, even boredom. Now, in the spirit of efficiency, we’ve begun medicalizing death itself.

In his unsettling essay “The European way to die,” French novelist Michel Houellebecq warns that the normalization of euthanasia and assisted suicide is not a sign of progress but of profound cultural decay. I didn’t expect to find myself agreeing with him.

As a physician for over three decades, I’ve …

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How one man’s dying wish was denied by the health care system

Physician
August 5, 2025

“This is Dr. Mohr.” I answered a number I didn’t recognize.

“It’s Irving,” said the frantic voice. “He collapsed. The paramedics are working on him now.”

“They’re doing compressions? Stop! Put the paramedic on the phone!”

My father-in-law, Irving, the stoic Danish-American Navy veteran, had been on hospice for 3 months. His POST (physician order for life sustaining treatment) form was on file with the hospice agency and his custodial care facility: DNR/DNI, …

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Why terminal cancer patients still receive aggressive treatment

Physician
July 31, 2025

Recently, researchers examined whether there had been any changes in the way terminal cancer patients died from 2014 to 2019, given the increased information available on hospice, palliative care, and advanced end-of-life planning (EOLP). They asked whether those who were terminal continued aggressive treatment until their demise. The authors anticipated a decrease in this, but found that the frequency of cancer patients who continued aggressive therapy had not declined. The …

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Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

Conditions
July 29, 2025

“It is a sad state that fear of liability will oftentimes negate the moral choice made by a terminally ill patient.”
– Journal of Air Law and Commerce

Background

In August 2024, I gave a presentation, “You’re suing me because I kept your mom alive? Avoiding wrongful life lawsuits.” I discussed the consequences for medical staff when they disregard a valid DNR and revive a person, against their wishes. There are numerous nationwide …

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