Judith Nelson has wrestled death firsthand like few people.

She specializes in end-of-life care. A doctor in the intensive care unit of one of America’s most highly regarded hospitals, she regularly serves people on the edge of life, grappling with the unknown beyond.

“Nobody wants to die. And nobody wants to die badly,” she says.

Nelson recently appeared in a heart-rending Frontline episode called “Facing Death,” about doctors and families at New York City’s Mount Sinai Medical Center struggling with the raw, painful decisions involved in treating terminal patients.

How much have you thought about it? There is something remarkable, even noble, in this near-universal quality among people and all living things. We want to shelter and preserve the spark of life we possess.

Inhabiting perishable bodies, living in an ephemeral world, we pretend life is permanent. Then, rudely, reality intrudes. Our bodies age and fail. Our friends pass away. Our families suffer loss. And still we are loath to face it. Even in intensive care, where it hangs in the air, the words die, dying and death are almost never uttered.

Dr. Nelson’s profession peddles hope. To patients stricken with fatal conditions, it offers an ever growing menu of treatments. A chance of escaping the inescapable.

But as that Frontline program makes clear, it also creates some gut-wrenching conundrums, and raises questions that are deeply important to consider.

Medicinal and therapeutic innovation expands the decision-making capacity and responsibility for people facing death. “[T]here’s almost always something else that we can do to put off the inevitable—another course of chemotherapy, a little bit more radiation,” says David Muller, dean of medical education at the Mount Sinai School of Medicine. “What if we got one more cat scan? What if we explored this person’s belly one more time? There’s always the nagging concern in the back of your mind, ‘Have I really left no stone unturned?’”

On top of that, machinery makes it possible to keep a body’s vital functions operating—heart beating, blood flowing, lungs pumping—almost indefinitely.

While offering promise to sick patients, these possibilities have also created a formidable set of expectations for modern medicine to live up to.

And in most cases, Dr. Nelson says, it is not equal to the task. “[T]he availability of the therapies has created this fiction that we can orchestrate this one way or the other, when the truth of it is that, for all of this magnificent technology, the underlying illness and the medical condition of the patient are far and away the most important factors in determining the outcome,” she says. “But it feels like, when you have the technology available, that your decisions to use or not use it are like the decisions to allow life or not allow life. And that’s not a position that any of us wants to be in.”

Understandably so. It’s a striking byproduct of contemporary health care. Nobody wants to die. Death is an intimidating enemy; it has never been easy to confront. But accepting the reality of a body succumbing to a fatal disease becomes more difficult when accompanied by the notion—however false—that it was a choice. I choose death. Do not resuscitate.

Given that choice, fewer and fewer take it. Per person, Americans spend more on health care than any other people worldwide; the bill totaled $2.5 trillion last year. More Americans now die in hospitals than anywhere else, often after significant medical intervention. According to Dr. Nelson, there are about 100,000 critical patients on artificial respirators at any given moment in America. Monetarily, their treatment generates a bill of $20 billion to $25 billion per year. But there is another, more intangible cost.

“[T]hese are the broken survivors of intensive care,” Nelson says. “And the better intensive care gets, the more of these broken survivors we have.”

At the heart of the issue is a painful paradox.

Doctors are applying the utmost of their intellectual and creative powers to pursue the fundamentally benevolent goal of giving individuals a valuable, albeit fleeting gift: more years of precious life. More years to deepen relationships, to create memories, to share wisdom, to dare exploits, to fulfill dreams.

At the same time, they recognize that it is impossible to indefinitely defy human mortality. And in many cases, the treatments actually harm the patients, diminishing quality of life and hastening death. Thus they, along with patients and their families, confront agonizing choices about how much therapy to administer, treading uncertain ground, guided by probabilities and feelings.

Three in four Americans say they believe in life after death. But just what that might be remains shrouded in mystery for most people. They simply have never closely examined the subject.

Modern medical advances have clearly added years of life—of varying degrees of quality—to many people. At the same time, these advances have enabled us to put off the fundamental questions that our mortality raises. With death looming, we become preoccupied with essentially material concerns—options, treatments, schedules, odds. For so many, the last days of life are spent not in peace, but in warfare, armed with faith in the frail weapons of science. We pour what little life we have into fighting the enemy that will end it. And ultimately, that “rage against the dying of the light” always ends in defeat.

Modern medicine promises a kind of immortality. It suggests that our energies are best put toward employing every means to extend physical existence as long as possible. If we are not careful, this “fiction,” as Dr. Nelson termed it, can preempt the important spiritual concerns that should dominate our thinking, even our decision-making, as we contemplate the inescapability of death.

What is the real purpose for life? What does happen after death?

“If in this lifeonly we have hope in Christ, we are of all men most miserable,” wrote the Apostle Paul.

This was a man who faced death with confidence. “For I am now ready to be offered, and the time of my departure is at hand,” he wrote. “I have fought a good fight, I have finished my course, I have kept the faith: Henceforth there is laid up for me a crown of righteousness, which the Lord, the righteous judge, shall give me at that day: and not to me only, but unto all them also that love his appearing.”

What he alluded to was not an empty hope of extending his physical life—but the true hope expounded in Scripture.

It is a hope founded in understanding God’s wonderful purpose in creating man mortal, subjecting us to the trials of the flesh—an experience that, in order to fulfill that purpose, He even put His only begotten Son through (e.g. Hebrews 2:9). It is a hope embedded in God’s perspective on the end of physical life: “Precious in the sight of the Lord is the death of his saints” (Psalm 116:15). It is hope in the promise of the resurrection—that, “as in Adam all die, even so in Christ shall all be made alive”—and that ultimately, “The last enemy that shall be destroyed is death” (1 Corinthians 15:22, 26).

There is a reason—a wonderful, inspiring reason—that something within us clings to life. A reason we crave permanence, even as our physical existence passes like a shadow. We were, in fact, created to inherit eternity.

How much have you thought about it?