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I’ll never forget my intern year. I saw patients with no chance of recovery—intubated, on dialysis, tubes in every orifice, their bodies kept alive while their quality of life was completely ignored.
No one was having conversations with them or their families about what was happening. No one was explaining the real impact of these treatments. The goal was clear: avoid death at all costs.
One patient in particular broke me. A patient, riddled with complications, lay intubated, on dialysis, with a Foley catheter and a rectal tube for C. diff—unable to speak, unable to decide. There was no conversation about goals of care. No discussion of the suffering these treatments were causing. The family had no idea they even had a choice.
When I asked my attending if we should talk to the family about goals of care, he waved me off. My senior residents warned me: Don’t push it. This isn’t your place.
But I couldn’t.
I called the family and had the conversation that no one else would. And you know what? They were grateful. No one had told them they had a choice. No one had explained what all these treatments actually meant for their loved one.
That moment changed me.
I later became board-certified in hospice and palliative care, largely because of what I witnessed during that year. But it wasn’t until my recent trip to Spain that I finally found the right term for what I had seen: encarnizamiento terapéutico.
Therapeutic cruelty.
A Spanish physician explained that over there, doctors call each other out when they see it. Not to shame, but because it’s the right thing to do. They understand that cruelty isn’t just excessive treatment—it’s failing to give patients and families all the information, failing to help them understand the trade-offs, failing to make them full participants in their own care.
We need to normalize this in the U.S. We need to speak up—not to shame, but to advocate. Every patient deserves to know the full picture: the benefits, the burdens, and most importantly, that they have a choice.
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