"When we foresee death"

“You’re always struggling against expectations. Something else can always be done; there’s always another test and another treatment. So it’s important to let people know when we foresee death. When I see patients who I think are at risk of dying, I say to the family and patient, ‘You could die during this hospital admission. Is that something you’ve been thinking about?’ Then you can go forward and ask, ‘What have you been thinking, and what are your expectations?’ When you plant the seed that death may be the outcome, people have more acceptance. They can initially be very shocked: ‘My goodness, I never knew he was that sick.’ They need time to come to terms with it. So you give them more time, rather than tell them in the I.C.U. that it’s time to turn off the ventilator. If you support them and attend to their needs, most patients and families are very accepting.”

-- Dr. Stephen Workman, an internist at the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia, in the NY Times New Old Age blog. 

See: http://newoldage.blogs.nytimes.com/2011/12/14/plain-speaking-at-the-end-of-life/