Western medicine is dominated by a single imperative — the quest for machinelike perfection in the delivery of care. - Atul Gawande

Consider the fact that we care deeply about what happens to the world after we die. If self-interests were the primary source of meaning in life, then it wouldn’t matter to people if an hour after their death everyone they know were to be wiped from the face of the earth. Yet, it matters greatly to most people. We feel that such an occurrence would make our lives meaningless. The only way death is not meaningless is to see yourself as part of something greater; a family, a community, a society. If you don’t, mortality is only a horror, but if you do, it is not. Loyalty, said Royce, solves the paradox of our ordinary existence, by showing us outside of ourselves the cause which is to be served, and inside of ourselves, the will which delights to do this service, and is not thwarted, but enriched and expressed in such service… Above the level of self-actualization in Maslow’s hierarchy of needs, they suggest the existence in people of a transcendent desire to see and help other beings achieve their potential.
As our time winds down, we all seek comfort in simple pleasures; companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces. We become less interested in the awards of achieving and accumulating and more interested in the rewards of simply being. Yet, while we may feel less ambitious, we also have become concerned for our legacy, and we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile.

In the end, people don’t view their life as merely the average of all of its moments, which after all is mostly nothing much, plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments; the ones where something happens. Measurements of people’s minute by minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life may be empty. A seemingly diffic

Technological society has forgotten what scholars call the 'dying role' and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among life's most important, for both the dying and those left behind. And if it is, the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame. Over and over, we in medicine inflict deep gouges at the end of people's lives and then stand oblivious to the harm done.

end-of-life discussions were an experimental drug, the FDA would approve it.