A widely circulated essay by physician Ken Murray posed an observation that had been quietly noted within the medical community but rarely discussed publicly: doctors, when they themselves are dying, typically choose far less aggressive treatment than the medicine they practice routinely offers their patients.

The pattern Murray described — physicians who understand what intensive end-of-life treatment actually involves often opting for comfort care, hospice, and minimal intervention when they face terminal diagnoses — raises a pointed question about the gap between what medicine can do and what it should do.

The reasons for this divergence are not simple. Part of it is information: doctors understand better than most patients what chemotherapy for stage IV cancer actually feels like, what a prolonged ICU stay involves, what CPR on a frail elderly person actually does. The medical system is structured to treat aggressively by default, and patients and families often equate more treatment with more care. Physicians who know what the treatments involve often make different choices when they become patients.

Part of it is also about what patients and families are really asking for when they request everything to be done. Often the desire is not specifically for the interventions themselves but for the feeling of not giving up, of having tried, of not having done too little. These needs are real and can sometimes be addressed in other ways.

The essay Murray wrote became one of the most widely shared pieces of health writing in recent years, because it named something that many people sensed but couldn't quite articulate: that death is not a medical failure to be overcome by sufficient intervention, and that preparing for a good death — one's own, or a loved one's — is a form of wisdom rather than surrender.