By Wesley J. Smith, J.D., Special Consultant to the CBC
The LA Times has an interesting story about whether doctors should tell imminently dying patients that they are about to expire. The question asked, is whether this is the right thing to do. From “Should Doctors Tell Patients When Death is Imminent:”
A study published online this week suggests that healthcare professionals keep patients fully informed in the final days and hours of life. Researchers in Sweden examined 1,191 cases in which patients were informed of imminent death and a similar number in which patients were not informed. The study showed no differences between the two groups regarding pain control, nausea, anxiety and other symptoms at the end of life — most likely because these symptoms are unlikely to change in the week before death.
But the patients who were informed were much more likely to have their preferences met regarding intravenous medications, such as morphine. They were also more likely to have died in their preferred place and their family members were more likely to be offered bereavement support and were prepared for the event. “People vary about the extent they want to know the truth, if they want to know at all, and in their understanding of what constitutes telling the truth,” the authors wrote. But, they concluded: “Being informed about imminent death does not lead to more unrelieved pain and anxiety during the last week of life.”
When doctors told me at the hospital after a health crisis that my dad was terminal with colon cancer, I went to his bedside. He looked at me beseechingly and said, “The doctors didn’t use the word ‘terminal,’ son.” What to do? I knew my father, and I was absolutely certain he wanted the truth. So, I said gently, “They did to me, Dad.” He nodded and sighed, opening an important conversation between us, the memory of which I choke up over even now, decades later. But I know dad benefited from knowing because he “let go” and focused thereafter on just living the time he had left (which turned out to be far longer than the doctors predicted.)
But not everyone is my dad, and his death was not imminent when we had that talk. Still, some people would rather not know, and from what doctors tell me, they find ways to communicate that. Neither way is “right” or “wrong,” it seems to me. (I am not referring to circumstances when a patient asks for treatment options and recommendations. Then, I think the doctor has to tell the full truth as part of the informed consent process.) Bottom line: Deciding when and how to communicate bad news in the best interests of the patient would seem to me to be an essential part of the “art” of practicing medicine.
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