What Price Paternalism?

I'm probably going to have a lot of thoughts about this Atul Gawande piece on hospice care, but here's a slightly off the wall question:  how much better off are patients now that doctors don't lie to them?  My understanding is that in the late nineteenth and earlier twentieth centuries, and possibly right up through the fifties and sixties, doctors routinely lied to terminal patients.  That's changed, partly due to changing cultural views about this sort of paternalism, and partly, I suspect, because we can somewhat extend peoples' lives by doing many unpleasant things to them.  Since no one would put up with this unless they knew they were dying, we have to tell them they're dying.

Gawande's piece, however, makes a pretty credible argument that a lot of the things we do are next to useless, prolonging neither quality nor quantity of life.  If that's the case, couldn't one possibly argue that we'd be better off if more doctors lied, made us comfortable, and let us enjoy our final days without constantly entertaining thoughts of impending death?

I don't like public paternalism, and I'm not much fonder of the private version.  But I'm genuinely curious as to what sorts of benefits people think we gain by knowing for certain that death is coming.  We romanticize the good death, but from what I understand, death has almost always been nasty and brutish, whether long or short.  How is it improved by knowing it's coming?  I haven't had a lot of relatives die, so I'm sure I'm missing quite a lot.  I'm hoping my readers can fill me in.

This article available online at:

http://www.theatlantic.com/personal/archive/2010/07/what-price-paternalism/60506/