Avoiding Death
Avoiding Death
Joy Stepinski, MSN, RN-BC
February 3, 2026
For the past year, we have examined the seven assumptions that drive excessive medical care, as described by Dr. H. Gilbert Welch in Less Medicine, More Health. This month, we review the very last assumption that medical care is all about avoiding death [1]. Welch states that most Americans desire to die peacefully in their own home with their loved ones without any medical equipment or alarms. Yet, hospitals are the most common place of death, according to the CDC [2].
The motto of “saving lives” has dictated healthcare for decades. Healthcare professionals and patients' families may assume that patients want their lives to be saved. Often, patients believe that their families would want everything possible done for them and opt to try treatments to demonstrate care for their family.
The author states that extending life may not always be desirable or achievable for the patient. For instance, the patient may be offered a treatment with a low chance of survival and significant side effects. Sometimes, there are better outcomes when medical providers are less aggressive. One study described by the author investigated palliative care versus standard treatment options for metastatic non-small cell lung cancer. Of the 151 patients randomly assigned to one of the two groups, results showed that patients with earlier palliative care demonstrated better quality of life, fewer depressive symptoms, and survived longer than those with standard treatment [3]. Medication can have similar effects. An abundance of drugs may be prescribed to manage symptoms, but patients may feel better once they discontinue certain pharmacological treatments.
Why is this topic so important to decision-making? As Welch states, life is not always about avoiding death [1]. Reflecting on the medical care that you want can be placed into perspective by your life goals and values. Finding meaning in one’s own quality of life can shape the goals for care. “Embrace life. And don’t dwell on death – recognize that it’s part of life (p. 183).
References:
Welch, H. G. (2015). Less medicine, more health: 7 assumptions that drive too much medical care. Beacon Press.
Centers for Disease Control and Prevention Morbidity and Mortality Report. (2020). QuickStats: Percentage of Deaths,* by Place of Death† — National Vital Statistics System, United States, 2000–2018. https://www.cdc.gov/mmwr/volumes/69/wr/mm6919a4.htm
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., ... & Lynch, T. J. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742. https://doi.org/10.1056/NEJMc1911892