Just Because We Can, Should We?

In the end-of-life planning workshops I facilitate, the same question comes up again and again: How do I deal with my family? More specifically, how do I tell a son, daughter, niece, nephew, or spouse what I want to happen when I can no longer speak for myself?

What sits beneath that question is something deeper. Most families are very good at solving problems. They are much less comfortable with simply supporting a person through uncertainty, decline, or hard choices. One of the goals of these conversations is to help families move from fixing to supporting.

Modern medicine complicates this in powerful ways.

I’ve had my hips and knees replaced. Those conversations were straightforward. The surgeries were likely to improve my quality of life, and they did. The promise was clear, the trade-offs manageable, and the goal, returning to function, made sense.

But not every medical decision fits that pattern.

A friend of mine is living with rectal cancer. We visited him in the hospital a few weeks ago. According to his daughter, the medications he’s on allow him to function, but he is largely bedridden. He went home a few days later, knowing, and with his family knowing, that if he stops taking those medications, he would not survive.

He understands this. His family understands this. And still, the situation exists in a kind of suspension.

When people phone or visit, he sounds upbeat. He’s pleasant, engaged, and reassuring. I’ve seen this before. When my mother was dying of cancer, visitors would come for short visits, half an hour at most. She put on a brave face. My niece did the same when she was ill. For those brief moments, everyone participated in the illusion of wellness.

It’s a kindness, in a way. But it also sustains the unspoken belief that “normal” might return if we just try hard enough.

Modern medicine offers extraordinary possibilities, surgeries, injections, replacements, and medications that extend life and relieve suffering. But alongside that promise comes pressure. The pressure to keep going. The pressure to pursue the next option. The pressure to treat uncertainty as something to be solved rather than lived with.

The question: Just because we can, should we? isn’t about rejecting medical care. It’s about informed choice. About weighing risk against reward. About recognizing when treatment supports a person’s life, and when it merely postpones a conversation no one wants to have.

Families often support the idea of “getting back to normal” because it feels hopeful and loving. But sometimes that hope delays clarity. It postpones decisions that deserve time, honesty, and shared understanding.

Medicine can do remarkable things. The challenge is knowing when its role is to restore and when it is to support comfort, dignity, and choice. Wisdom lies not in doing everything possible, but in doing what aligns with the life and the ending that a person wants.