Truth and Consequences
If you were terminally ill, would you want to know? Would you be one to ask, “How much time have I got left Doctor?” I suspect that most of us would answer yes. We would feel the need to make plans, arrangements, and help prepare loved ones. But is complete disclosure always the right answer? Probably not.
The New York Times reports on the Doctors’ Delicate Balance in Keeping Hope Alive. In a poignant article, author Jan Hoffman writes about the difficult balancing act between hope and despair that doctors face when dealing with the seriously ill.
Assessing his 23 year old AIDS patient, Dr. Sacco knew her medical options amounted to a question of the lesser of two evils: either the more aggressive ventilator, on which she would probably die, or the more passive morphine, from which she would probably slip into death. But there was also a slender chance that either treatment might help her rally.
He also knew that how he presented her options would affect her decision, the feather that would tip the balance of her hope scale.
I know a family who lost a member to terminal cancer a number of years ago. I saw first-hand the damage that can be done by false positives and cheerful platitudes. When the patient died his family felt angry and betrayed by his physician, who had just days before told them how good his test results were, an indication that he was responding well to chemo. I doubt that the doctor actually said the patient was getting better, but that is understandably what the family heard.
After the patient’s death the doctor steadfastly avoided family members and their questions. They were left feeling that they simply no longer mattered.
I suspect that it was more that the doctor used avoidance to distance herself from grief. Part of me is sympathetic, doctors are human too.
The power of a doctor’s pronouncements is profound. When a doctor takes a blunt-is-best approach, enumerating side effects and dim statistics, in essence offering a hopeless prognosis, patients experience despair.
Efforts are being made across the medical community to grapple with the language and ethics of hope.
It’s an important discussion. I hope it continues.
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