Death is the elephant in the room: it is there, but most people refuse to acknowledge it. Death is normal. We live. We die. It does not discriminate. It is unavoidable. As Kahlil Gibran told us in The profit‘…life and death are one, just as the river and the sea are one.’

No one doubts that death stings. It can be tragic, unwarranted, untimely, and vicious. And, while few people die of something called ‘old age’, it’s generally accepted that the longer you live, the closer you get to getting out. So make sure you die happy.

While acknowledging the wonder and achievements of modern medicine, Atul Gawande (be deadly), a surgeon, believes that modern medicine, when faced with the realities of aging and death, has gone too far. Today’s health professionals, he says, have come to see death as a failure and resort to “medicalizing” the aging process with expensive remedies, more drugs, more procedures, more institutional care and new forms of therapy. And, even when all hope is dashed, conversations about assisted dying often involve a medical approach.

There are limitations to what medicine can hope to offer. That’s why Gawande advocates, as we age, not only for health care, but also for achieving a meaningful life. He cites surveys showing that those who are aware of impending death want not only to prolong their lives and alleviate their suffering, but also to strengthen their relationships with family and friends. They want to live more authentically and with greater integrity; feel that your life has been valuable.

To achieve this, the old need help to continue quality of life instead of prolonging life by extraordinary medical means. It’s like Seneca told us a couple thousand years ago, adding years to life without adding life to those years is a waste of time.