Why do you think it's so difficult for doctors and/or families to refuse or curtail treatment? How should priorities be set?

Often medical treatments do not work. Yet our society seems to favor attempts to "fix" health problems, no matter the odds of their success. Dr. Gawande quotes statistics that show 25 percent of Medicare spending goes to the 5 percent of patients in the last stages of life. Why do you think it's so difficult for doctors and/or families to refuse or curtail treatment? How should priorities be set?

Worries about malpractice threats, the constant bombardment of drug commercials, new medical treatments that offer even a glimmer of hope, and basic survival instincts, these are all things that influence our decisions to give it our best shot, no matter what the odds. Once again priorities need to be based on what the patient sees as most important.

It is difficult because they don't know your mind. You must set your desires and make them known to your doctors and family.

We don't want to lose a loved one. We all wish they could be with us "one more day!" Actually, we wish them to be with us for months or years! We aren't ready to let go. We want that miracle cure that will prolong life. Doctors don't want the family saying he/she hadn't done everything possible. Everyone needs to listen to what the patient wants.

We're going through a hard time in my older daughter's family right now. Her mother-in-law has just been diagnosed with terminal cancer, and has decided to forgo treatment. She's been given a few months to live. I'm curious as to what her doctors have to say about her decision - so far (and it's only been a fw weeks since we got the news - she didn't tell us for a while) they seem to be supporting her. As is her son, her only child, although it's tremendously hard on the whole family. Serendipitously, I lent my daughter this book just before hearing her m-i-l's news. What timing!

We live at a time, in a country, where we don't need to face mortality the way people used to. We are bombarded with health, beauty, youth. Being old is no longer seen as something to respect, but to be managed. Cancer is a rude interruption to the stories we are being told. There is no grace in illness or aging or dying. We are allowing ourselves to be cut off from reality because we don't know there is beauty in it, just like there is in living. No one wants to have difficult conversations for fear of seeming hard or mean. Yet, that is exactly what is happening when the conversations are avoided or circumvented. People who wish to curtail or even stop treatment don't feel they have the authority to decide - yet, they do. My father, diagnosed with colon cancer, decided not to accept any medical intervention. It took a bit of convincing, but we all were privileged to watch him move through the staged and be a part of his life as he died gracefully, with laughter, love and palliative care. Should I enter the same journey, I will do the same. It means everything.

Our loved ones are always hoping that we will beat the odds and achieve that "miracle cure." Doctors view death as an enemy to be defeated, rather than as a fate that each of us will ultimately face. The priorities were well spelled out in Dr. Gawande's book. What does the patient want? What does the patient fear? How do you want to spend your final days?

I enjoyed reading all of the above perspectives and agree with all of them. Ultimately, our loved ones don't want to see us go, but it should be about what the patient wants, what is best for him/her. I appreciated the doctor who asked the patient what he wanted, and the patient replied, "to eat chocolate and watch football." And asked patients what they feared. If we can take that fear away and leave them with chocolate and football, that's a good thing.

Families don't want to lose their loved ones and the doctors feel they must try everything they can to save them. We all know we are going to die someday, but it's very scary when you are given a terminal diagnosis. I hope when faced with those decisions I can be like the man that wanted to be able to eat chocolate ice cream and watch football. The patient's wishes should be the number one priority. Families and medical workers need to honor those wishes.

Doctors don't like to admit defeat. And most families keep their feelings inside so can't be open to wants and needs of the patient and, to a lesser degree, family members. The priority, without question, is with the patient.

I agree with deeh and darylb. You need to follow the patient's wishes. It is hard to watch a love one die but knowing it is what your loved one wants helps. I know because it was hard watching my father die under hospice care but it was what he wanted. I am at peace with it because he had a long, happy life.

Doctors are trained to preserve life, and families want their loved ones around them for as long as possible. That's what makes it hard to make objective decisions that are in the patient's best interest. I'm buying this book for my two adult children and requiring them to read it - after all my husband and I have done for them so willingly and lovingly, the least they can do is read Dr. Gawande's book.

I presented this question to two medical students I mentor through O.S.U. Both students said refusal or curtailment of medical treatments went against everything they were being taught. They are taught to "FIX IT", and not to accept it. I also asked them about writing a prescription to assist a terminal patient's suicide. Again both said absolutely not, they were not prepared to make that choice. I gave both students a copy of the book and suggested they read it before our next interview. It will be interesting to hear their thoughts then. As a Christian senior citizen I firmly believe I should be given the choice and opportunity to say "enough" when I become terminal for whatever reason.

I recently was informed about a medical form called a POLST which allows a person to indicate his or her preferences for treatment should they become terminally ill. This form supersedes living wills which are often not followed by EMT's who are required to begin treatment during ambulance transport. I also feel that one's family and attending physicians should be aware of the POLST form in plenty of time before it becomes necessary to make a decision. This way it is all spelled out in advance what a person wishes in the event of his approaching death.

What I learned with my dad was that when he ended up in the ER because of a fall or pain, the doctors would treat his symptoms and send him back to the nursing home. It was like all they saw was an old man and they didn't even try to find out what was causing the problem. During his last ER visit before his death, I kind of blew a gasket and yelled at the doctor on that subject. If nothing can be done, everyone needs to accept that. The person needs to be made as comfortable as possible for their last days and left to live their life as they choose. Priorities should be set by what the person wants and by whether treatment is really going to make a difference in the long run. And people need to get their advance directives (healthcare power of attorney) prepared and let their family know where the papers are and what they want. Because children can be advocates for their elderly parents wishes when those wishes are understood.