“I’m ready to go.”
That afternoon, the patient looked at the sunlight spilling across the hospice floor and said quietly, “It’s about time.” He spoke calmly, as if describing his breakfast. Unlike my feelings toward an English breakfast, he did not cry, choke up, or show pain. He simply sat there. In that moment, I thought he looked like a child waiting for the school bus, knowing it had arrived and it was time to leave.
I stood there, unsure what to say. I realised I had not yet learned how to bear the weight of a life.
When a patient expresses a wish to end their life, modern medicine tells us to screen for depression. Yet the man before me was not escaping pain. He simply had nothing left worth waiting for.
The frightening thing is not death itself, but its uncertainty. Whether in Heidegger’s “being-toward-death” or the Stoics’ “living through death,” mortality is no stranger. Sometimes death even allows people to let go. I have seen a patient with depression whose symptoms eased after being diagnosed with late-stage cancer.
The real anxiety comes from knowing that night will fall, yet never hearing its approaching footsteps. If we knew it would arrive tomorrow, perhaps we could still persuade ourselves to savour today. Instead, it hides somewhere in an indefinite future.
There may be people to see or tasks to finish, yet uncertainty makes them hard to plan. The body grows weaker, and each day offers fewer things to do. It is like being a long-distance runner without a finish line, or a traveller waiting for a delayed train while the announcement repeats, “Thank you for your patience.”
What follows is life’s “garbage time.” Usually, garbage time is harmless. There is always another chapter, and in the worst case, you can quit and try again. But the garbage time of life is like reading a serial novel you already know will end abruptly. Will you keep turning the pages, or stop?
That patient told us he hoped for a painless death. Painlessness is not difficult. Whether from breathlessness or internal bleeding, modern medicine can relieve suffering. But the final act of ending life is something we cannot do.
I have often questioned the meaning of prolonging life when a patient has clearly given up the will to live. Yet what does “clearly” mean? Patients with depression are treated against their will. Those with anorexia are force-fed. We say their illness impairs judgment, but what we call illness is shaped by society’s shifting consensus on life and death.
Palliative care, however, does not use many resources. These patients are not kept alive in the ICU, connected to endless machines. They are simply accompanied toward the end.
If doctors were allowed to end life, new questions would appear. Who qualifies? Only late-stage cancer? Mental illness? Who decides for those who cannot speak for themselves? There are no universal answers.
Perhaps it is better to draw a clear line: a doctor’s duty is to prolong life while preserving dignity, not to choose its ending. This line must be guarded.
The meaning of life, however, can only be found by the patient. It might be beginning a new project, seeing the light on a flower petal, or simply sharing an embrace with a stranger.
As a doctor, I will guard a patient’s life within the limits of my profession.
As a fellow human being, I will step one small pace beyond that line to give him a hug, even if that is all I can offer.
