Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

I talked to over two hundred patients and family members about their experiences with aging, serious illnesses, and the big unfixables. But I also spoke with scores of physicians, and especially geriatricians, palliative care doctors, hospice nurses, and nursing home workers. The biggest thing I found was that when these clinicians were at their best, they were recognizing that people had priorities besides merely living longer. The most important and reliable way that we can understand what people's priorities are, besides just living longer, is to simply ask. And we don't ask.

A failure often does not have to be a failure at all. However, you have to be ready for it-will you admit when things go wrong? Will you take steps to set them right?-because the difference between triumph and defeat, you'll find, isn't about willingness to take risks. It's about mastery of rescue.

One of the reasons people might be fallible, why we might fail to do what we try to do isignorance, that we have a limited understanding of the laws of the world - the physical laws that govern the world and of all the particulars of the world upon which those laws work. And then there's ineptitude, meaning that the knowledge is available, but individuals fail to apply it correctly. The third source is "necessary fallibility." That is, we're never going to be omniscient, there is some knowledge that we will simply never achieve, and there are limits to what we will be able to do.

The evidence is that people who enter hospice don't have shorter lives. In many cases they are longer.

Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.