When someone you love is sick, especially if they’re elderly or have a serious condition, you want to do everything possible to help them. You ask about treatments, you research specialists, you drive to appointments, you cling to hope. And often, you say yes to whatever the doctor recommends.
But what if more medical care isn’t always the answer?
What if more machines, more medications, more hospital stays aren’t helping your loved one live better, but just longer?
This is the hard but important message that Dr. Bernardo Gutierrez delivers in his book Prognostication: Principles and Practice. It’s a message meant not only for doctors, but for caregivers like you, the spouses, children, and friends who stand at the bedsides, make decisions, and ask, “What should we do now?”
Sometimes, the best care means doing less. And knowing when that time comes is one of the most important and loving things you can learn.
Why “More Treatment” Feels Safer (But Isn’t Always)
In today’s healthcare system, doing more is the default. There are specialists for every organ, machines to keep people breathing, and treatments that can prolong life for days, weeks, or months. As a caregiver, you’re often told what can be done, not what should be done.
That puts you in a difficult position. Saying “yes” to more care feels hopeful, responsible, even moral. Saying “no” feels like giving up.
But Dr. Gutierrez, a physician with nearly 50 years of experience, urges us to stop and ask a different question:
“Are we prolonging life, or are we prolonging the process of dying?”
It’s a powerful distinction. One that too few families are encouraged to explore.
Understanding the Natural Curve of Decline
One of the most helpful lessons in the book is the idea that life follows a curve a natural rise, a peak, and a gradual (or sometimes sudden) decline. Illness, aging, and frailty are not failures of medicine. They’re part of being human.
Too often, though, doctors and families treat this decline as something to fix, to push against, even when the body is shutting down. But fighting nature at that stage may only lead to more pain, confusion, and costly interventions that don’t change the outcome.
“It is essential to avoid futile care,” writes Dr. Gutierrez.
Futile care means treatments that don’t offer real benefit that might keep the body alive, but take away comfort, dignity, or time with loved ones.
As a caregiver, knowing how to recognize this moment and how to speak up is key.
What You Can Ask the Doctor
It’s not easy to question a medical recommendation. But it’s your right and your role to advocate for care that truly serves your loved one. Here are some questions you can ask when faced with a difficult decision:
- “What’s the goal of this treatment?”
Is it to cure? Stabilize? Prolong life? Provide comfort? - “How will this affect their quality of life?”
Will they be in pain? Able to speak, eat, move, or recognize family? - “What happens if we don’t do this?”
Sometimes, doing nothing (or choosing palliative care) leads to a more peaceful end. - “Are we helping them live or helping them die more slowly?”
That last question may be the hardest. But it can also be the most clarifying.
The Caregiver’s Guilt
One of the hardest burdens caregivers carry is guilt. Guilt for not doing enough. Guilt for making the “wrong” choice. Guilt for choosing comfort care over another round of treatment.
But here’s the truth: being a good caregiver doesn’t mean extending someone’s life at all costs. It means supporting their wishes, honoring their values, and walking with them even when the path leads to goodbye.
Many patients, when given the choice, choose comfort, not aggressive care. They want to be home. They want to be pain-free. They want to spend their final weeks with family, not in an ICU.
You can help make that possible. And there is nothing to feel guilty about when you do.
Reclaiming the Human Side of Medicine
Dr. Gutierrez’s book offers a quiet but powerful challenge to today’s medical system: Remember the patient. Not just their diagnosis or vitals, but their story, their wishes, and their stage in life.
Caregivers are a vital part of that story. You are the bridge between the clinical world and the real world, the voice asking, “What would my loved one want?”
By learning about prognosis, the likely outcome of an illness based on age, function, and medical history, you can ask better questions, make clearer decisions, and protect your loved one from unnecessary suffering.
When Saying “No” is a Loving Act
We live in a culture that praises fighting “battling” cancer, “beating” disease, and “never giving up.” But there is strength, too, in acceptance. In recognizing when the battle is over. In choosing peace, dignity, and meaningful time over tests, tubes, and isolation.
Saying “no” to more medical care doesn’t mean giving up.
It means showing up with clarity, with love, and with the courage to choose what truly matters.
A Final Message from Dr. Gutierrez
At the heart of Prognostication: Principles and Practice is this belief: that both living and dying are natural, and we should not make either more difficult through unnecessary care.
If you are a caregiver in the trenches of illness, grief, and love, this book is for you. Not because it has all the answers, but because it will help you ask the right questions.
And sometimes, that’s the greatest gift you can give.
If you’re a caregiver, family member, or friend supporting a loved one through serious illness,
Consider reading Prognostication: Principles and Practice by Dr. Bernardo A. Gutierrez.
It’s a clear, compassionate guide to making medical decisions that respect both life and dignity.
Available now on Amazon.