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    "original_url": "https:\/\/www.nytimes.com\/2026\/09\/28\/opinion\/hospital-good-death.html?emc=edit_nn_20260928&nl=the-morning&segment_id=227179",
    "parsed_content": "AdvertisementSKIP ADVERTISEMENTOpinionSupported bySKIP ADVERTISEMENTGuest EssayA Hospital Death Can Be a Good DeathSept. 28, 2026, 5:03 a.m. ETCredit...Illustration by Shoshana Schultz\/The New York TimesListen \u00b7 6:01 min Share full articleBy Daniela J. LamasDr. Lamas, a contributing Opinion writer, is a pulmonary and critical care physician at Brigham and Women\u2019s Hospital in Boston.See more of our coverage in your search results.Encuentra m\u00e1s de nuestra cobertura en los resultados de b\u00fasqueda. Add The New York Times on GoogleAgrega The New York Times en Google What is a good death? We tend to imagine a good death as one that takes place at home, far from the sounds and smells and lines and tubes of an intensive care unit, like the one where I work.I believed this for many years. But after a decade as an I.C.U. doctor, I\u2019ve come to think we need a different definition of a good death.A death at home can be the right thing for a patient and his or her family. But it is not inherently better. An I.C.U. death can be peaceful and dignified. A death at home can be panicked and painful. Yet we have built a culture, and quality metrics, that treat I.C.U. care at the end of life as a failure.Fifty years ago, most Americans died in hospitals, often receiving painful, aggressive interventions that they might not have wanted had they truly understood their prognosis. Today, the share is under a third. The rise of hospice and palliative care, which is largely responsible for this profound change, gave patients and families something medicine had too often failed to provide: permission to stop aggressive interventions, to focus on comfort over cure, sometimes to be at home.AdvertisementSKIP ADVERTISEMENTSomewhere along the way, home stopped being one possible place to die and became the place where a peaceful, good death was supposed to happen. Medicare now tracks, as a marker of poor-quality cancer care, the percentage of patients admitted to the I.C.U. in their final 30 days of life; intensive care became something to be measured and minimized. The presence of lines and tubes became almost synonymous with suffering. And sometimes this suspicion is right. There are surely still I.C.U. deaths that happen because no one told a family the truth in time, because a patient kept escalating through interventions and no one ever said the word \u201cdying.\u201dSign up for the Opinion Today newsletter Get expert analysis of the news and a guide to the big ideas shaping the world every weekday morning. Get it sent to your inbox.But sometimes intensive care is the right place to care for a dying patient. Some symptoms, like terrifying breathlessness or pain that changes hour to hour, are best controlled with medications that a nurse at the bedside can adjust minute by minute. Some patients decline too quickly to be moved. Some patients, knowing exactly how sick they are, will never be ready to stop trying interventions that could buy them more time. And sometimes we don\u2019t yet know whether a patient is dying. Prognoses are not as certain as they once were, even for diseases that were once uniformly fatal. And so in many cases, we choose to begin what\u2019s called a \u201ctrial of critical care\u201d \u2014 essentially, we offer the suite of I.C.U. interventions, but not indefinitely if a patient is not improving.I recently cared for a woman with advanced cancer and widespread bone metastases who had developed what was either pneumonia or a reaction to one of her chemotherapy drugs. She was dying of her cancer, that much was sure. But there was a chance that her lung disease was reversible, that it could respond to antibiotics or to steroids and she could have more time. Her oxygen levels were so low that she was struggling to breathe, so short of breath and terrified that we had to make a decision quickly.In a family meeting outside the room, I pushed her daughter not to move ahead with intubation and instead to treat her mother\u2019s pain and shortness of breath with medication alone, knowing that she would die. \u201cShe has suffered so much already,\u201d I told her. But her daughter did not think her mother wanted that path. She understood that her mother had terminal cancer. But if there was a chance that her mother could have more time, she wanted it.Refusing critical care could have caused its own kind of suffering: the fear that they had stopped too soon. We intubated with the plan that if she did not improve over the coming week, we would take out the tube, and allow her to die comfortably.AdvertisementSKIP ADVERTISEMENTShe did improve, but only marginally. Her clinical uncertainty and symptoms meant that home was never going to be possible, nor was it desirable. In the end, she died without shortness of breath or fear, with the sedation that only an I.C.U. can provide and with her daughter at her bedside. It was not the death that I had been taught to call a good one, but it was as good as it could have been.Home hospice can be deeply meaningful. For many families, there is comfort in caring for a loved one in familiar surroundings, with hospice offering not only medical support but also care for the family and, later, bereavement support. Families often report greater satisfaction with hospice than with hospital care. But home is not always the easiest place to manage the complexities of dying. For patients with severe or rapidly changing symptoms, a nurse is not down the hall at 2 a.m. When pain or breathlessness becomes difficult to control, families can panic and call 911.I\u2019ve become far more hesitant to recommend home hospice than I was a few years ago, and I try to tell patients and families plainly: A death in the hospital does not mean they have failed. But the cultural script that tells us that love looks like dying at home is powerful, and it leaves people who couldn\u2019t make that happen \u2014 for reasons of symptoms, of resources, of fear \u2014 certain that they let someone down.I recently cared for a man in his 50s with esophageal cancer who was dying. I encouraged my team not to push his family toward home hospice, but this is what his loved ones thought was the right thing to do.The day before my patient was to go home on hospice, his symptoms increased and he needed more medication overnight, meds that would have been impossible to give comfortably had he gone home. We decided that he would stay in the I.C.U. His family members were not upset; if anything, they were relieved. They had thought going home was something they should do for him, but they weren\u2019t sure they were equipped to do it.AdvertisementSKIP ADVERTISEMENTHe died in our hospital, with family at his bedside. Those family members were free simply to be his family \u2014 holding his hand, not try to manage his medications. I don\u2019t think that can be called a failure.Source photographs by Hugo Avila and Ryan McVay via Getty Images.The Times is committed to publishing a diversity of letters to the editor. We\u2019d like to hear what you think about this or any of our articles. Here are some tips. And here\u2019s our email: letters@nytimes.com.Follow the New York Times Opinion section on Facebook, Instagram, TikTok, Bluesky, WhatsApp and Threads.AdvertisementSKIP ADVERTISEMENT",
    "published_at": "2026-09-28T09:03:44+00:00",
    "author_name": "Daniela J. Lamas",
    "site_name": "The New York Times",
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    "ai_headline": "A Hospital Death Can Be a Good Death",
    "ai_simplified_title": "Daniela Lamas Argues Hospital Death Can Be Good Death",
    "ai_excerpt": "A critical care physician challenges the notion that a 'good death' must occur at home, arguing that hospital settings can provide dignity and comfort for dying patients, especially those with complex symptoms.",
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