By Dr. E.S. Krishnamoorthy
We live in a world that celebrates survival. Modern medicine trains doctors and nurses to fight disease, to extend life, to revive and restore. What it doesn’t often prepare us for is the one thing we cannot avoid: death.
In this edition of Neurokrish Immersion, Dr. Ennapadam S. Krishnamoorthy explores the uncomfortable silence around end-of-life conversations. Why do we shy away from discussing death, even when it stares us in the face?
The Discomfort Around Dying
Death is often treated as a failure. Hospitals become factories where life ends in sterile, mechanical ways. This is a far cry from the peaceful departure many wish for: at home, pain-free, surrounded by family. Yet, modern healthcare rarely supports this vision. Terminal patients often remain unaware of their prognosis, shielded by well-meaning families and reluctant doctors. Their death, in effect, is stolen from them.
What Makes a Good Death?
Fear is central. Fear of the unknown. Fear for loved ones. And yet, death does not have to be devoid of peace. Cultural and spiritual frameworks provide meaningful context. From Tibetan Buddhism’s bardos to Hinduism’s karmic cycle, from Islamic submission to the Christian idea of divine will, these belief systems shape how we perceive the end of life.
Quoting physician William Osler, “Death that fulfills the debt of nature is the easiest of deaths.” But to reach that ease, we must reframe how we prepare for it.
Dementia: The Long Goodbye
Dementia brings death into slow focus. Patients lose memory, self-awareness, and ultimately their identity. The indignity is profound — not knowing who you are or who cares for you. Worse, dementia is rarely seen as a terminal condition, and its end-stage realities are often obscured, both medically and culturally.
Who Decides?
In traditional societies, decisions about death are communal. The extended family takes charge. Authority figures often influence end-of-life choices. In today’s world, especially with globally scattered families (the so-called “Parents in India, Children Abroad” syndrome), this becomes complex.
Advanced care directives, or living wills, are tools meant to preserve agency. But they are not easy to navigate. Cultural taboos, religious beliefs, emotional conflicts, and legal ambiguities all act as barriers.
Challenges and Conversations
Dr. Krishnamoorthy identifies the 3A challenges:
- Availability of trained professionals to support end-of-life discussions
- Acceptability within cultural and familial contexts
- Accountability, ensuring these decisions are not misused
In many families, every member may have a different opinion about what should happen to a terminally ill parent. These decisions carry deep emotional and moral weight, and often, guilt.
Why Talking About Death Matters
As Atul Gawande writes in Being Mortal, “Patients die only once. They need doctors and nurses who will help them prepare for what is to come.” The silence around death does more harm than good.
To die with dignity, as Nietzsche put it, in the arms of one’s family should be a right, not a rarity. But it requires open conversations between patients, caregivers, professionals, and loved ones.
Final Thoughts
Aging, illness, and death are not failures of life. They are part of it. Planning for them is not a sign of giving up, but of respect. Respect for the person, for their values, and for the journey that life truly is.
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