The Contract of Existence: Acknowledging Mortality and Medical Futility at the End of Life




Vining, Paul

Access rights

Worldwide access

Journal Title

Journal ISSN

Volume Title



Medicine’s role in the process of dying has evolved in response to continued patient demands for highly invasive procedures to delay the end of life. These demands reflect a larger phenomenon, wherein death’s once omnipresent nature has been lost in modern western society. This has led to a general unfamiliarity with death, and patients often postpone acknowledging the inevitability of their finitude by persistently pursuing extensive treatment over palliative care. Such decisions arise from the sentiment the tenacious pursuit of treatment is akin to a noble struggle against the end while palliative care is synonymous with acquiescence. Despite this perception, palliative care offers an environment in which a healthy acknowledgement of death’s proximity is encouraged. For authors such as Michel de Montaigne and Leo Tolstoy, it is from this acknowledgement that patients in end-of-life scenarios may prioritize the time they have left, thus allowing for commiseration, grief, and catharsis to contribute towards a meaningful death.



Palliative care., Medical futility., Mortality., End-of-life care., Advanced directives., Attitudes towards death., Tolstoy., Hospice., Contemplation of mortality., Non-beneficial treatment., Medicalization of death., Montaigne.