The central concern of the book is how to best face human mortality. Modern medicine tries to vanquish death but of course cannot succeed at this task. But because mortality is not faced candidly, too many individuals suffer through procedures that don’t offer any real hope at prolonging life. Likewise, patients suffer by keeping their thoughts and fears about death bottled up, a requisite response since acknowledging mortality is often seen as admitting failure or giving up. Gawande imagines a better way, one in which modern medicine does all it can do in the face of illness and human suffering, while also admitting that frailty and death are part of the human condition.

Gawande states:

at least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality—the courage to seek out the truth of what is to be feared and what is to be hoped. Such courage is difficult enough […] but even more daunting is the second kind of courage—the courage to act on the truth we find (355).

Throughout the book, Gawande notes the moments when he had or lacked courage, and when he was able to summon up the strength to have a difficult conversation with a patient, or, alternately, when he avoided it.