There is a particular kind of hallway that Jessica Bunin, MD, knows well. A family stands in it, paralyzed, guessing at what the person they love would have wanted, because no one ever asked while there was still time to answer calmly. Bunin has stood on the other side of that hallway too, the one who has just done compressions on a patient whose organs were already failing, whose cancer could not be cured. She is direct about what that looks like. "It is not a rescue," she says. "It is broken ribs while a family in the hallway holds onto hope that is already gone."
Research has long suggested that physicians, at the end of life, tend to choose far less aggressive intervention than their patients do. Bunin's own wishes track that pattern precisely, and she offers a specific explanation for it: she has seen, from a vantage point most people never occupy, what aggressive intervention actually delivers in the final stages of terminal illness. That proximity has not made her fatalistic. It has made her precise about what she wants and what she does not. No CPR under those circumstances. No mechanical ventilation when breathing is not the problem. What she does want is morphine, the people she loves close enough to touch, and a sky she can still see. "That is not surrender," she says. "That is clarity, finally turned toward myself."
The conversation she wishes more families would have goes well past the standard checkbox of resuscitation status. She wants people talking about what a good death actually looks like to them, where it happens, who is present, whether more time or less suffering carries more weight. Those are not morbid questions, in her framing. They are protective ones. "That conversation is a gift you give the people who will one day speak for you when you cannot speak for yourself."
One tension she returns to is the gap between what patients tell their doctors and what they tell their families. Patients confide in physicians that they do not want any more treatment, she says, but they are afraid to say that to the people closest to them. The reasons are not hard to imagine: fear of disappointing someone, fear of being seen as giving up, the weight of a cultural vocabulary that equates fighting with virtue. Bunin pushes back on that framing directly. "Someone was a 'fighter' in life does not mean that they deserve a painful death."
The word deserve sits in that sentence with some force. It reframes the question entirely, from what a patient is willing to endure to what they are owed. What a person who has fought hard through illness is owed, Bunin implies, is an honest conversation while they can still participate in it, and a death shaped by their own wishes rather than by the silence that accumulates when no one asks the right questions in time.
