FINISHING STRONG: "Everything about our current system is designed to resist agency in our dying. It can be hard to achieve the ending you want--harder than you think, but... it indeed is possible to finish as strong as we have lived.".

• Author: Lee, Barbara Coombs
• Position: MEDICINE & HEALTH

AS A YOUNG NURSE, intensive care and emergency rooms were my specialty. I loved the blend of high technology and bedside care. I believed that comforting attend veness, clean sheets, and a backrub contributed as much to the recovery as all the machinery and medicines did.

Still, I was comfortable with the darker side of intensive care, too, inserting large-bore needles into fragile veins; passing tubes down noses and throats to suction or feed; sedating bodies that bolted against the ventilator forcing air into their lungs; tying arms and feet to bedframes when delirious or angry patients thrashed and pulled at their lines. These things were routine and I never questioned them.

In the early 1970s, palliative care was unknown and hospice was in its infancy. When a hospital patient died, it usually was after a long period of "code" activity. The curtains were pulled around the bed; family was excluded; and a bevy of doctors, nurses, and trainees cut, poked, pounded, shocked, intubated, passed tubes, connected machines, and delivered medication every way possible, including through long needles directly into the heart. Sometimes a doctor would even cut open the chest and massage the heart directly.

When all of this failed to revive the patient, which was almost always, we broke the sad news to the family and reassured them that "we did everything possible" to save their loved one. Those words were considered to be the kindest, most-comforting message at a time of heartbreak and loss.

Twenty years later, high hopes that medical technology always would extend life had faded. Awareness had dawned that a long, drawn out "full code" was just brutal torture of a dying body, and it often left the family traumatized. Now, full codes were applied more judiciously, and often abbreviated if the effort failed to produce results within the first few minutes. Our words of comfort when a person died were just as likely to be "he passed very peacefully."

It was not until May 20,1994, that I heard the words of comfort that seemed to usher in an age when people find solace in knowing a beloved has completed life on his or her own terms. That was the day after Jacqueline Kennedy Onassis died of non-Hodgkin's lymphoma. Her son, John F. Kennedy, Jr., emerged from her apartment and comforted the crowd that stood grieving on Fifth Ave.: "My mother died surrounded by her friends and her family and her books. She did it in her own way and on her own terms--and we all...