A Dignified Death

October 2025 | Vol. 69, No. 3
Written by Melissa P. Broyles, DO

A typical Qliq message reads, “Routine Palliative Care consult to discuss goals of care with family. Patient is Sylvia S. in ICU 468.” The chart describes a somnolent 100-year-old woman with advanced dementia, admitted due to dehydration and subsequent acute-on-chronic kidney disease. When I speak with her daughter, I learn that Ms. Sylvia, fondly called so by her students, was a beloved kindergarten teacher for forty years and a devoted mother of four. Her daughter shares that she had poor oral intake for two weeks prior to admission and had stopped eating and drinking entirely in the last two days.

At Ms. Sylvia’s bedside, she lies in peaceful stillness—frail, beautiful, and unmoving. Her heart monitor blares repeatedly, alarming for a heart rate of forty-eight, yet she does not stir. Suddenly, behind me, a determined attending physician and medical resident rush into the room with a consent form and surgical tray in hand—not due to Ms. Sylvia’s heart rate, but because they are on a different mission. To my surprise, following a specialist’s suggestion, they intend to place an access line in her neck to initiate dialysis.

Instinctively, I take a defensive stance, arms stretched as if guarding a goal on the basketball court. The goal here is to protect Ms. Sylvia. Politely, I ask the attending physician for time to speak with her daughter. After our discussion, the decision is made to forgo dialysis and other life-sustaining treatments. What the family, and perhaps the other physicians, did not realize was that Ms. Sylvia was not dying because she wasn’t eating or drinking; rather, she wasn’t eating or drinking because she was dying. Choosing to forgo dialysis was not an act of abandonment, but an act of love. An acceptance that Ms. Sylvia’s precious hundred years of life had been approaching the end. As physicians, we are trained to prolong life, which is a noble pursuit. However, in these moments, the best act of care is knowing when not to intervene, but to protect a dignified death.