My mother-in-law is coming to the end of a long battle with chronic kidney disease and has chosen not to continue dialysis. Because she seems depressed, her physician ordered a consultation with a psychiatrist, who thinks she'd benefit by discussing certain family issues that date back to her childhood. She's not interested in that and wants to focus on saying good-bye to family and friends. What do you think?-J.W., MO.

Not everyone has to die in a state of psychoanalytic grace.

I'm convinced that we usually die the way we've lived. If your mother-in-law hasn't addressed these matters with a therapist in the past, why would she start now? I doubt those issues are at the root of her depression. She's preparing to leave everything and everyone she loves. Of course she's depressed. It's called preparatory grieving.

I once worked with a terminally ill patient with a history of repeated admissions to a psychiatric hospital. An immigrant from Russia, he'd had problems adapting to life in the United States. He spoke to me of joining the Russian army at age 16 and enduring many hardships. His wife and son confirmed his stories; they also shared with me their troubled life at home with Mr. Melnikov.

On some visits I found him lucid and loquacious. Other times he was irritable and contentious. But I liked him and told him so.

The week before he died, his wife told me she wanted him to have "shock" (electroconvulsant) therapy. She felt it would erase all his "bad" thoughts and they could have a final, peaceful conversation. Obviously this never was ordered.

I sat with Mr. Melnikov on his last day. He still had a few demons haunting his thoughts but, at one point, he gently touched my face and said, "Thank you for believing me."

There was much about his past that a psychiatrist could have explored. But in the end he was just another mortal trying to take his leave with a little dignity.