A surgeon's reflections on the care of the dying.

The characteristics, such as authority, power, certainty, and coolness under fire, that most surgeons consider essential to their ability to fight disease can be counterproductive in the care of the dying. Surgeons have begun to recognize that the ages-old image we have been taught to cherish must undergo some changes if we are to fulfill our responsibilities to those for whom our usual aggressive methods of treatment are to no avail. For this to happen, introspection and evaluation of the "inner surgeon" are required, in order to discover and deal with the hidden motivations that often influence decision-making at the bedside. The result of such self-analysis can be liberating. The new way of perceiving ourselves may bring us increased equanimity and break down some of the barriers that have stood in the way of effective palliative care.