Can versus should: Public expectation and the high-intervention death - A practical guide for clinicians.

Abstract

Escalation of medical intervention near the end of life has become increasingly common, often driven by public misperceptions of medical capabilities, cultural narratives of 'fighting' disease, and clinicians' discomfort with discussing limitations of more extreme treatment regimens. The result is the high-intervention death: intensive, invasive and frequently misaligned with patient values. This article examines the dynamics underpinning these decisions from the perspectives of emergency medicine, intensive care and palliative medicine. We describe the consequences of late acceptance of dying, the absence of advance and future care planning, and societal unpreparedness for death. We propose practical strategies to support better decision-making, including early goals-of-care discussions, compassionate communication, and a cultural shift towards acknowledging death as a realistic and acceptable outcome. Restoring humane, value-aligned care which still includes a plethora of treatments, albeit less invasive ones, requires clinicians to balance medical capability with compassion, clarity and courage.