Conversations about death and dying are widely recognised as essential to caring for incurably ill patients, yet doctors consistently find them among the hardest to initiate. That tension sits at the centre of a recent opinion piece published in The Guardian, written by oncologist Ranjana Srivastava.
The difficulty of initiating the conversation
Srivastava draws on a personal clinical encounter to frame a broader argument. A patient with whom she has shared a long-standing professional relationship pauses during a consultation to ask about her children — a small, humanising moment that underscores the mutual nature of the bond between doctor and patient. The author reflects that goodwill in medicine does not flow in one direction only; it is exchanged between both parties over time.
That relational depth, the piece suggests, does not make end-of-life discussions easier. If anything, it can complicate them. Doctors who know their patients well carry the weight of that history into every consultation, including the ones that require the most difficult honesty.
Holistic care for incurably ill people has to include discussions about death and dying – but getting there is hard.
Holistic care and what it requires
The central argument Srivastava advances is that genuinely holistic care for those living with incurable illness cannot stop at symptom management or treatment planning. It must extend to frank discussion of what dying may look like, and what a patient's wishes are as that process unfolds. Avoiding those conversations, however understandable the impulse, leaves a gap in care that no clinical intervention can fill.
The piece does not offer a simple remedy. Instead, it acknowledges the structural and emotional barriers that make such discussions rare in practice — barriers that exist on both sides of the consultation room.
A call for cultural change in medicine
While Srivastava writes from personal experience, the argument she makes is systemic. The reluctance to discuss death is not simply an individual failing; it reflects broader patterns in how medicine is practised and how doctors are trained. Changing that, the piece implies, requires more than individual willingness — it requires a shift in what the profession considers standard care.
The Guardian piece does not present data or cite clinical studies. It operates instead as a reflective account, using the texture of one clinical relationship to illuminate a challenge that is, by most accounts, widespread. Whether that approach moves the conversation forward in any measurable way remains to be seen, but the argument itself — that silence around dying is a form of incomplete care — is one that surfaces repeatedly in medical ethics literature.