( CNN ) -- Life is difficult . Death used to be simple . You simply died , and that was it . Now , in the modern era of high-tech medicine , death is difficult , too . The predicament facing Nelson Mandela , who has been critically ill for the past five weeks and turns 95 on Thursday , brings into sharp focus an important question that eventually affects all of us . How do we want to die ? Mandela is one of the most influential and important people on Earth , but nothing about his situation is unique or special . Intensivists -- those doctors who specialize in intensive care patients -- will tell you that every day thousands of people all over the world are going through the same thing . Playing out the end game , many of them are stuck on a ventilator with a slim to vanishing chance of ever getting back to the life they knew and loved . Modern society is confronting a tragic , silent epidemic of frail elderly people who suffer needlessly at the end of life because of unwanted life support . These folks are effectively left to die a slow death connected to machines . As a critical care specialist who has seen this process play out many times , it can be agonizing to witness . How did we end up here ? Why has death become so complicated ? Modern medicine is powerful , but it is a double-edged sword . The way we can bring people back from the brink of death is truly amazing . There is nothing more satisfying professionally than having a grateful patent walk back into the ICU after surviving a near-death experience . But more often , for very old people , aggressive life support does n't work out so well . Prolonged ICU care often gradually evolves into a checkmate situation . Intensivists know what it usually means when the condition of an elderly person hospitalized for weeks is described as `` critical but stable . '' After weeks of aggressive support , the patient still can not survive off the ventilator . When this happens , the muscles start to wither away from a condition called ICU-acquired myopathy . Little may seem to be happening , but as the body inevitably continues to weaken , a relentless series of secondary complications will ensue , such as pneumonia , delirium and failure of the circulatory system or kidneys . In most cases , patients need to be continuously sedated to minimize obvious pain and suffering . When do you stop ? How do you stop ? And who decides ? These are the wrenching issues that confront the family . The fundamental question is this : When is it time to accept the inevitability of death , change the goal of care to comfort , and let the patient have peace ? It used to be that doctors struggled with withdrawing life support , or would n't even consider it . At the height of the Jack Kevorkian era in the mid-1990s the chairman of our hospital ethics committee , a good friend and colleague , told me that withdrawing life support should always be difficult and make me uncomfortable . I could n't have agreed less , but I did n't tell him . Thankfully over the years , his views and those of most physicians have changed . Unlike my generation , medical students are now trained in ethics and palliative care . More patients have advance directives and living wills . Every intensivist will tell you that withdrawing life support and helping someone `` make the transition '' with comfort and dignity is one of the most satisfying and useful things that they can do . But despite this progress , there is still a fundamental disconnect . The epidemic of futile support at the end-of-life persists . The major reason is a perfect storm created by the power of modern medical technology , our cultural emphasis on patient autonomy and the innate human tendency to deny and hide from the reality of death . Death is scary and makes us uncomfortable . Modern culture has insulated us from witnessing death . We are out of touch with the life cycle . We deny death . We also believe that the patient should call the shots and get the care he or she wants . But what happens when the patient can no longer express his or her wishes ? Spouses , children and family are forced to make life-and-death decisions that they never volunteered to make , sometimes may not be equipped to make , or unrealistically assumed they would never have to make . But make no mistake : Unless death is sudden , one day you will need to decide when to allow someone you love to die , and someone will have to make that decision for you . Intensivists often hear this : `` I know my dad would n't want this , but I just ca n't bring myself to do it . '' Advance directives or a living will do not necessarily mean you will get the end-of-life care that you want . This is because withdrawing life support depends on your decision-makers , usually your loved ones , understanding and believing that you are past the point of no return . It depends on accepting death . Mandela fought for freedom all of his life , and the world does not want to lose him . Now all we can hope for is that he is comfortable , and getting the care that he would want . If and when the day comes that he has fought long enough , it will be OK to let him be free . The opinions expressed in this commentary are solely those of Stephan A. Mayer .
Stephan Mayer : Critically ill for five weeks , Mandela makes us think of how we want to die . Mayer : There 's an epidemic of people suffering as they die hooked up to machines . He says we deny death , are scared , do n't want loved ones to go , allow medicine to prolong life . Mayer : One day you might need to decide when to allow someone you love to die .