A surgeon, Nuland taught bioethics and the history of medicine at the Yale University School of Medicine. As he was nearing retirement, a book agent asked Nuland if he would consider writing a book about what happens to a person, medically, as they die. “I thought surely there were hundreds of books already” on the subject, Nuland said later, but there weren’t — not for doctors, nor for lay people. He took a year off to research and write the book. The result, in 1994, was How We Die: Reflections on Life’s Final Chapter — and it was a sensation. It was a New York Times Best Seller, won the National Book Award for Nonfiction, and was a finalist for the Pulitzer Prize. Nuland then did retire, and spent the rest of his professional life writing.
In How We Die, Nuland concluded that “death with dignity” was not likely for most, and that suffering was common, which was prolonged by too-aggressive treatment by doctors. Nature “will always win in the end,” he said. “The necessity of nature’s final victory was accepted in generations before our own. Doctors [in the past] were far more willing to recognize the signs of defeat and far less arrogant about denying them.” The book started much-needed debates over end-of-life care, and who should make such decisions. He urged doctors to accept loss as a part of life, and stop treatments when they knew the end was near so their patients could die at home, with their families, rather than in a sterile room disturbed by beeping monitors. “Only by a frank discussion of the very details of dying can we best deal with the details that frighten us most,” he said. Nuland’s work gave momentum to the hospice movement, and palliative care for the dying. As he had wished, Dr. Nuland died at home — on March 3, from prostate cancer. He was 83.