After a hospice nurse increased my mother's morphine drip to ease her feeling of drowning, she never spoke to me again. By then, her metastatic lung cancer had taken nearly everything: her strength, her vigor, her independence. What remained was breathlessness that came in waves, each more frightening than the last. The morphine was meant to quiet her panic and soften the suffocation. It did. It also closed the door on any final conversation.
I was both daughter and oncologist, and the weight of those roles was devastating. I understood what was happening physiologically from decades of treating patients. That knowledge did nothing to make it easier to sit at her bedside, waiting for her to wake, unsure if she could hear me or say goodbye.
The Myth of Control at the End of Life
We talk about end-of-life care as if it offers comfort, dignity, and control. But for many patients, the ability to decide how they die never fully arrives. Hospice physicians reassured me that the medications did not accelerate death. Watching her slip away so quickly made that difficult to believe.
Two months earlier, my mom had dyed her hair platinum blond. Her short, thinning pixie was suddenly bright. She insisted on going out in a leather jacket and stiletto heels, her oxygen tank trailing behind her. Even as her body failed, she was determined to remain herself. That determination made what followed harder to accept.
The Unspoken Option: Medical Aid in Dying
In the end, she had no control over how she died. No one should endure preventable agony when death is inevitable — not my patients, not my mother, not anyone. Yet many are left with only a few paths forward. Medical aid in dying is often framed as a moral or legal debate. Despite the controversy, it is rarely used. Surveys show that approximately 70% of patients say they would want the option if faced with terminal illness, yet only about 1% ultimately receive it. Medical aid in dying allows terminally ill patients, under strict conditions, to request and self-administer medication to end their life while they still have the capacity to decide.
As oncologists, we are trained to prolong life and intervene, so these discussions come late. Patients hesitate to raise the topic because they worry it will signal defeat. Physicians falter, concerned about taking away hope.
A Patient Who Needed the Truth
One weekend on call, a distraught intern stopped me in the hallway. He asked if I could speak with a patient on his service, a woman with metastatic colon cancer who had been in the hospital for a month with a bowel obstruction. Her oncologist had written in her chart that there were no further chemotherapy options and that her care should be continued by the hospital team. No one had told her she was dying yet.
When I met her, she was tethered to tubes that kept her alive, but no longer living. We talked about her condition and about her faith. She spoke openly about her relationship with God and believed death would bring her closer to Him. She did not need convincing. All she needed was someone to name what was already unfolding. She told me she wanted to go home with hospice.
What Dying Actually Looks Like
Doctors rarely tell patients what dying actually looks like. If they did, it would sound like this: Dying from advanced cancer is rarely a gentle fading. It is almost always unrelenting nausea, confusion, and decline that makes someone unrecognizable. It is the gradual loss of independence and, eventually, death. In hospice settings, you hear its footsteps: the rattling in the throat, the low groaning. You see the body weaken, become emaciated, the eyes sunken.
I am watching this again. I did not expect to sit at a loved one's bedside again so soon; this time, watching my father disappear the same way my mom did. He is dying of metastatic prostate cancer. He spent his career as a physician, guiding patients and their families through death. I can already see the outlines of how this may end.
A Father's Denial, a Daughter's Burden
His oncologist was direct and kind at our last in-person visit. He told my father chemotherapy would bring side effects without meaningful benefit. My father listened, but he was not ready to hear it. He said it gave him hope. Then his oncologist said what few physicians say plainly: “If you were my parent, I would not recommend treatment. At this point, many people choose to enter hospice. I would begin to prepare.” It was also something my father could not accept. He believes his shrinking world is part of being 84 — not the tumor taking over his bones. He still believes there is time for outdoor concerts and trips to the beach.
That gap — between what he believes and what I know — has left the hardest conversation to me. When I touch his back now, I can feel his spine through his skin. When he sleeps more, I know this is not rest. He does not want to hear any of this, and so I have learned to hold what I know in one hand and what he needs in the other.
We met with his oncologist by video after he began using a walker, when he could no longer stay up for a full conversation or leave the house. The visit was brief. His oncologist was cheerful. His oncologist has discussed hospice as a theoretical option but has never said the word death. Since that conversation did not happen, it now falls to me.
The Weight of Honesty
Before difficult conversations, I paused outside a patient's door, hand on the handle, steadying myself before walking in. I knew what it would require of me, and that once I spoke, I would change how they understand the rest of their life. There were times I felt like a fraud. Who was I to tell someone how their life was going to end? Now there is no door to stand outside. There is only my father, sitting across from me.
But with my father, I feel the pull to wait. To soften. To leave something unsaid. It is one thing to guide a patient through the end of life; another to name it for your own parent. With patients, I could call honesty compassion. With my father, it felt dangerously close to betrayal.
He has no desire for food or water, and I know what often comes next. Hospice physicians explain that when patients stop drinking, death will follow within days. I have also been in conversations where, when patients say they are ready to die, hospice doctors may recommend no longer drinking any fluids. I find myself wondering whether to say that out loud to him.
When the Option Arrives Too Late
Decisions about how one wishes to die are resisted and take time to absorb. In many situations, it is families — daughters, sons, partners — who carry this responsibility. Not in exam rooms, but in the home, long after the appointments end. In Illinois, where I practiced, medical aid in dying will be legal in September. My father will likely die over the summer. If that option existed now, I would make sure he understood it while he was still well enough to make that decision himself and request it. Instead, it will arrive just after he is gone, sparing us a conversation neither of us may be ready to have.
Though every one of us will die, we are remarkably unwilling to talk about it. We speak of fighting and never giving up, as if death itself were a failure rather than the natural end of life. A choice like medical aid in dying that patients are too afraid to ask for is not real, and one physicians don't discuss may as well not exist. As a physician, I have tried to guide people through those moments. As a daughter, I am far less certain of my duties.
The Only Gift Left
Recently, I recommended hospice to my father. I felt everything move in slow motion, my breath catching before I could get the words out. My father recoiled at the idea, despite leading these same conversations as a physician himself. He told me he was trying to live as long as he could for me. I quietly told him he could let go. That I did not want him to suffer. That I would be there.
I am not his oncologist. I am not responsible for shaping how this ends. I am his daughter, sitting beside him. He does not want another plan or an explanation. He wants me to rub his feet and tell him about my daughters' summer plans. So I do. I sit beside him in the silence. I hold his hand when the fear comes. That is what remains when everything else falls away.
After a lifetime of being cared for by our parents, some of us are given the chance to steady them at the end. We can sit beside them, tell the truth when they are ready to hear it, and stay. This Father's Day, that is the only gift I know how to give him. Not another explanation. Just presence. And I see, finally, that this is all I am meant to do.
Jennifer Obel, M.D., is a retired oncologist who conducted clinical research on goals of care and quality of care for terminally ill patients. She dedicates this essay to the patients who faced death with open eyes, held their families close, and let her be present at the end.
