Skip to Main Content

Last Acts

Discovering Possibilities and Opportunities at the End of Life

Palliative care physician Dr. David Casarett considers the medical options terminal patients face at the end of life in this thoughtful and illuminating guide to last acts.

What would you do if you had only a few days to live? Or a few weeks or months? What if a loved one were in this situation—how could you help that person decide how to spend the time that remained? Perhaps you lost a family member or dear friend to a terminal illness and were baffled by that person's choices. How do you make sense of his or her last acts?

Dr. David Casarett, a palliative care physician and researcher, specializes in the care of patients near the end of life. Drawing on his years of experience and the stories of patients he has treated, as well as his own research, he explores the wide variety of ways in which people spend their last days. Why do some people choose to be altruistic, while others are vengeful? Why do some leave a legacy, while others prefer to celebrate and enjoy their time with family and friends? Why do some fight and struggle to the last minute, while others accept their fate and use their limited time to reconnect or reconcile?

The tremendous diversity of these last acts makes clear that there is no formula for dying well or choices that are right for everyone. At the same time, these stories reveal that some choices may be harmful to the dying person or those closest to him. Last Acts helps dying patients and their families think about the possibilities that exist at the end of life, so they may choose to spend their time in ways that help bring them peace of mind.

Photograph by Joe Chielli, Church Street Studios LLC

David J. Casarett, MD, is an associate professor of medicine at the University of Pennsylvania’s Division of Geriatric Medicine. He is a staff physician and a palliative care consultant at the Philadelphia Veterans Affairs Medical Center and director of research and education for the University of Pennsylvania’s Wissahickon Hospice. Dr. Casarett's research into end-of-life care has been supported by the Veterans’ Administration, the National Institutes of Health, the Paul Beeson Physician Scholars program, and other foundation awards and grants.