Let me just start with a case, as is our tradition in medicine.

So consider this case.

Abe Anderson is a 50-year-old carpenter.

He and his wife are proud parents of twin daughters.

And one day, Abe's wife notices his eyes look yellow.

Abe goes to see his doctor.

Imaging reveals a tumor in the pancreas with multiple lesions in the liver.

A procedure is done to place a stint in Abe's bile duct, and biopsies confirm everyone's

fears.

Metastatic pancreatic cancer.

What does it mean to care well for aid, Anderson?

To be a good physician to him in the future that he faces.

Closely related to this question, it seems to me, is another.

How does the work of palliative care practitioners, I'm a palliative medicine

doc myself, how does our work fit into good medicine for aid? And these in medicine may seem like

rather anodyne questions, but my argument this evening will be that the answers that are

characteristically given to these questions and the assumptions that underlie those answers are

wrong. I'll argue that in order to practice medicine well for Abe Anderson, clinicians will need to reject the way

that contemporary medicine typically frames care for patients at the end of life and recover an older

and more adequate framework.

So let's start with how we got to where we are now.

Since the advent of the mechanical ventilator, at least,

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