The issue of 'Letting Go' is a very personal one, and different people have widely varying views (as we all know). I'm all for 'Letting Go' when the time is right. But I also not for giving up when there is a battle that can be one. I can also respect patients who, because of their 'warrior spirit' or for whatever reason, want to go 'down fighting', although from my standpoint this isn't usually a good idea.

I also take your point, that while we in hospitals endeavo(u)r to be patient-centered, the bottom line is that if you come to hospital, you will get hospital care. The onus is on us, however, to help decide when the hospital is no longer the place to be. Hospices and the hospice movement are light years ahead of us in terms of helping the dying.

It is hard to achieve dignity in the act of dying -- perhaps Sherwin Nuland is right: “The dignity we seek in dying must be found in the dignity with which we have lived our lives. Ars moriendi is ars vivendi: the art of dying is the art of living.” (from http://www.yalealumnimagazine.com/issues/00_10/…). Knowing more about our patients lives before they became gravely ill may help us help them have a dignified end, but is much harder on us emotionally.

Like you I think advanced directives are important. Perhaps more important is discussing with your loved ones what you, and they, want when the time comes, because it will come…