When It’s Time to Die: The Need for Palliative Care Training
It's important to know how to discuss death in surgical care.
Posted June 1, 2026 | Reviewed by Monica Vilhauer Ph.D.
Have you ever had to tell someone that they are dying?
For me, the first patient I recall was a 20-year-old woman, who was the first clinic patient I saw as an Immunotherapy and Surgical Oncology Fellow at the National Cancer Institute over 16 years ago. She was being treated for metastatic melanoma, and the disease had returned and spread to her brain. My job as the doctor was to deliver this news and to tell her that there were no more treatment options available. I was 29 at the time, and in no way prepared to deliver such devastating news, especially to someone who was so near my own age. I saw myself in her and began to contemplate my own mortality, and what it would mean if I were the one on the receiving end of such news.
As a surgeon, I, along with my colleagues, am trained over a five-year or more period (with additional years added on for fellowships) to determine the differential of disease processes, and how to best help — to cut or not to cut. And while delivering bad news is felt to be a part of surgical residency training, studies have shown that residents do not feel competent in doing so. One study found that less than half (46%) of residents would rate their perceived competence as “good;” just 36% said it was “very good.”
In my field of trauma and surgical critical care, and in many other surgical specialties, such as surgical oncology, transplant surgery, or cardiothoracic surgery, the word death must not be seen as taboo. Helping patients and their families cope with the possibility of dying is increasingly recognized as crucial to surgical training, as evidenced by one study, which had greater than 90% of the faculty reporting that the graduating chief residents needed more training in conducting goals of care and end of life conversations.
As I discuss with patients and their families, the one true element of life that we all share is that one day, every one of us will die. Sometimes, the only true decision that can be made is the way we choose to die — a quality of life versus quantity of life decision. I do not make that decision for patients or their families; instead, my role is to help facilitate the conversations and support my patients and their choices to the best of my ability. But these conversations are never easy. The American College of Surgeons has a committee on Surgical Palliative Care, with an online Surgeon’s Guide and Curriculum. There are one-year fellowship programs designed specifically for surgeons at higher education institutions, where surgeons can learn the skills involved in palliative care. The Center to Advance Palliative Care offers an online curriculum for General Surgery residents.
However, even with an increase in knowing the importance of training to care for patients at the end of their lives, and the opportunities to continue training with formal fellowships, few surgical residency programs offer any kind of training on how to conduct goals of care and end-of-life conversations. Multiple studies have shown that both residents and faculty alike believe that surgical trainees would benefit from a dedicated curriculum in surgical palliative care while completing their residency.
Surgical residents frequently are involved in the lives of patients who suffer from serious illness and injury, from cancer to trauma, many of whom will die from their disease. Discussing death and end-of-life care for surgical patients historically was seen as “ giving up ”— these attitudes are changing, but the education is not keeping up with the change in culture among surgeons.
As our population ages, end-of-life conversations are going to play a larger role in the care we provide our patients. By 2030, for instance, it is predicted that 1 in 5 people in the United States will be over the age of 65. It is imperative that the next generation of surgeons is comfortable addressing the topic of death. It is incumbent upon our training programs to teach a critical component in the care of surgical patients. Since it’s true that one day all of us will die, all trainees should finish residency able to address the topic of death. Sometimes, a death that involves a focus on the quality of a patient’s life, rather than the quantity, is the best medicine we can provide.
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Shannon Small, MD , is an Assistant Professor of Surgery at the Yale School of Medicine.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.