I have given hundreds of talks in my life. Lectures to medical students, presentations at conferences, seminars on diagnostics and evidence-based medicine. For all of them I prepared slides. Dozens of them, sometimes.
When Dr Pankaj Harkut, cardiologist from Nagpur, invited me to speak on dying with dignity at a physicians and cardiologists conference in Nagpur last month, I decided, for the first time in my career, to speak without slides. Without notes. Without anything between me and the audience.
I am not entirely sure why I made that decision. Perhaps because death is not a subject that belongs on a PowerPoint slide.
I walked to the podium and spoke for forty minutes.
Sitting in the front rows, I spotted several faces I had not seen in years — classmates from the GMC Nagpur batch of 1973. Ramesh Mundle. Avinash Deshmukh. Suresh Batra. Prakash Bhatkule. Ashok Ganjre. Men I had studied medicine with half a century ago, now themselves in the final chapters of distinguished careers.
There is something clarifying about speaking on death in front of people your own age.
I began with ancient India.
Death, in the Indian philosophical tradition, was never a medical event. It was a passage. The Mahabharata, the Upanishads, the Bhagavad Gita — all engage with death directly, unflinchingly, as an inevitability to be understood and accepted, not fought and denied. Our ancestors did not consider dying a failure. They considered it a destination.
Then came modern medicine.
Over the last century, medicine performed miracles. Infections that killed children became treatable overnight. Surgical techniques that once seemed impossible became routine. The average human lifespan doubled. These are genuine triumphs and we should not diminish them.
But somewhere in the pursuit of those triumphs, medicine made a quiet, consequential error. It began to treat death as a problem to be solved rather than a reality to be faced.
The result is visible in every large hospital in India today.
Patients die in ICUs, alone, surrounded by machines, away from their families, their homes, the smells and sounds and faces that constituted their lives. They die connected to ventilators and infusion pumps, with no one holding their hand. Their families wait outside on plastic chairs, receiving updates from strangers in scrubs.
We have made dying a medical event. In doing so, we have stripped it of everything that once made it bearable.
I have spent four decades at Mahatma Gandhi Institute of Medical Sciences in Sevagram. In that time I have watched many people die.
Some deaths were peaceful. Most were not.
The ones that stayed with me were not the dramatic ones — the resuscitations, the emergencies, the near-misses. The ones that stayed with me were the quiet ones. Patients who accepted their fate with a composure I could not always match as their physician. Patients who asked not for more treatment but for less pain, more time with their families, a chance to die at home.
Those patients taught me more about medicine than any textbook.
They taught me that there is a difference between prolonging life and prolonging dying. That comfort care is not giving up. That palliative medicine — relieving pain, controlling symptoms, supporting families — is not the consolation prize of medicine. It is, in many ways, its highest expression.
Acceptance of death is not defeatism.
A living will — a document in which a person specifies in advance what medical interventions they do and do not want at the end of life — is not a morbid exercise. It is an act of clarity and love. It spares families from impossible decisions made in the fog of grief. It ensures that the dying person’s wishes, not the hospital’s protocols, determine what happens in those final hours.
Living wills are barely discussed in India. That needs to change.
The Supreme Court of India recognised the right to passive euthanasia and advance medical directives in 2018. But awareness remains thin. Most families have never heard of a living will. Most doctors have never discussed one with a patient.
Two days after the conference, the organisers shared a video recording of my talk. I uploaded it to YouTube without any particular expectation.
What followed surprised me.
Within three weeks, 1,45,000 people had watched it. Fourteen hundred had subscribed. I received hundreds of WhatsApp messages, emails, and YouTube comments — some of them several paragraphs long. Personal phone calls came from people I had not spoken to in years.
A cardiologist wrote to say he was rethinking how he spoke to terminally ill patients. A woman wrote to say she had finally begun the conversation with her elderly parents that she had been avoiding for years. A young doctor wrote asking how to introduce palliative care into his hospital.
I read every message.
What struck me most was not the numbers but the relief in those messages. People were grateful — not for the talk itself, but for the permission it seemed to give them. Permission to think about death. To talk about it. To stop pretending it was not coming.
We do not need to be afraid of this conversation. We need to start having it — in families, in hospitals, in medical colleges, and in living rooms.
Death will come regardless. The only question is whether we meet it with fear and denial, or with honesty and preparation.
I know which I would choose.
If you would like to watch the talk, it is here: Dying with Dignity — YouTube
S. P. Kalantri is a physician at Mahatma Gandhi Institute of Medical Sciences, Sevagram. He writes regularly at sp.kalantri.co.in.
Excellent truth about life & death. Reality of life, death & doctor’s role in ICU, & in treating a patient in last stage 👍👍