Impending death – Is honesty always the best policy?

[naomi24]

At one time we hid the truth from the terminally ill, but now it’s common practice for doctors to tell them they’re going to die. Some accept it, but some live their last weeks and months in fear and hopelessness – and that’s very sad to witness. Families know their loved ones better than anyone, and are more likely to know how they will react to the bad news, so should they be consulted before the decision is taken by professionals to tell the patient the truth?

[craft1948]

I always said that I would want to know if I was dying, so as to get things in order. A few years ago I had a breast cancer scare, and I have never been so petrified in all my life. I now don't know if I'd want to know or not.

[starone]

From what I can remember, I believe there was some sort of court case where doctors were sued because they had not told someone they were going to die and it was considered a basic right that they should know. I can't remember the details of the case only that the one who was bringing the case to court won and so now the accepted thing that the patient must be told. Otherwise the doctors could be sued which as you know could be quite damning.

[naomi24]

^^Isn't that sad. If it's true, then the threat of legal proceedings override compassion - and the best interests of the patient.

[askyourgran]

I'm an ostrich, I don't think I would want to know that I had a few months to live. On the other hand my mother wasn't told that she had two small tumours on her brain which were making her dizzy and falling over, at 92 she was deemed too old to do anything about it. We, her children had been told two weeks earlier about the tumours. Then she fell and knocked herself out ending up in hospital with bruises on her face. From then on she was morphined until she died two weeks later, she never knew what she had, she never seemed to be in pain. I know that she wouldn't have wanted to leave us that way. if she had moments of realisation during that time she must have been bewildered and terrified. I wanted the treatment to stop but was told it would be cruel to bring her back. It upsets me a lot when I think of how she died. So perhaps it is better to know your lot.

[woofgang]

naomi I am sorry for your pain. Professionals don't always get it right, no matter how hard they try. In answer to your question, no I don't think that relatives should be consulted specifically about "telling" the patient, but professionals should make every effort to understand how the patient feels and what and how they want to be told.

[naomi24]

Woofgang, //I don't think that relatives should be consulted specifically about "telling" the patient, but professionals should make every effort to understand how the patient feels and what and how they want to be told. //

So how do you suggest professionals, without consulting the people who know the patient best, do that without implanting the idea of the finality of impending death, thus destroying any remaining hope?

[woofgang]

By doing what the good ones have always done, getting to know the patient and their loved ones, understanding their expectations and hopes (and fears) and communicating accordingly.

In the "old days" when the consultant decided what and whether the patient should be told often (usually!) without reference to anyone else, on several occasions, I was put in the difficult situation of being asked directly by the patient "What is wrong with me? why will nobody tell me what is happening?"
I guess it happened to me more because I used to take people on home visits out of the hospital to plan discharge or breaks at home. In those circumstances, for those people, the not knowing was far more terrifying than the (admittedly bleak) truth. Of course you don't "destroy hope" and the first thing i used to do was find out what the patient usually knew or understood which was usually more than the consultant (and relis) thought, and work from there to give them the information that they wanted.
Its a slippery slope when staff are permitted or expected to lie to patients, even by omission.

[naomi24]

Woofgang, //By doing what the good ones have always done, getting to know the patient and their loved ones, understanding their expectations and hopes (and fears) and communicating accordingly. //

If only hospital staff, working in overstretched hospitals and qualified in medicine rather than psychology, had the time or the inclination for that Utopian scenario - but they don't. It simply doesn't happen.

And it’s even more of a slippery slope for a patient who’s given information he doesn’t want to hear – and the families who are left to try, in the most difficult of circumstances, to pick up the pieces as best they can.

Incidentally, I too have considerable experience in the ‘caring profession’ – predominantly with the elderly – but clearly my experiences do not accord with yours.

[tommy-h]

definitley

[woofgang]

Yes naomi, my experience both personal and professional, recent and historical seems to be very very different from your own.

[naomi24]

Woofgang, I would say exactly the same - my experience is also both personal and professional - which leads us straight back to the original point, that being that people react differently to bad news, and therefore it's very wrong to fail to consider the impact that stark reality may have on some by blundering ahead and applying the same policy to all.

[LoftyLottie]

A really difficult subject, but it so depends on the individual who is dying. I have witnessed at close hand what the truth did to someone I loved very much and who would have been far happier not knowing. On thinking about it I really don't want to be told and have to discuss it with close friends and relations. Part of my ostrich personality I think. Even if I suspected I had a terminal illness (and I believe most people would suspect) I would want to push it to the back of my mind and not discuss it.
I think on balance I agree with Naomi on this - but I can't really be sure how I would feel in the circumstances. People are so different.

[joko]

i think they should just ask the person, perhaps even tell them not to answer straightaway and to have a think about it - obviously say this before the outcome as itd be suspicious

but i would be peeved if my family knew and were lying to me

some people have things thyed want to do or say and may think 'oh well it can wait til im home then' and never get chance to do it.

[emmie]

Naomi think you know my thoughts by now, honesty perhaps, but the doctors don't always know, get it right. One could say you have x time to live, and because of circumstances, your own determination not to go down without a fight, it could be longer, or even in exceptional circumstances recover sufficiently to live a good deal longer. Having said that my o/h was given a time span as it were and he went far far quicker than the doctor said.

[Robinia]

I'm a bit late to this thread so in a nutshell I agree with what Sqad did...if the patient asks tell them the truth. If they don't let someone else know.
At the age I am now I'd want to be the first know but when I was younger and very ill my family were told I had no chance...no one told me. It was the best possible action...

[naomi24]

I know someone who was told she had 3 to 6 weeks to live - and a year and a half later she's still here. Shame she's spent the last 18 months worrying about dying!

[jomifl]

I was told about a year ago that I had a cancer that had spread to my lungs. My prospects would not have been good had it not been a case of mistaken identity. It was a somewhat traumatic experience but had it been a correct diagnosis I would have preferred to have known. As it was it gave me the incentive to re-arrange my affairs so that life would be less problematic for my wife in the event of my demise.

[owdhamer]

When i was first diagnosed with cancer i was given 6/ 24 months to live, i thought thats good i felt so ill the very day would be no surprise, my own doctor says the registrar was talking rubbish,
and it could be 5yrs. I dont feel so bad at the moment ,but still have bad days,

[woofgang]

One thing I am very strongly against, as I have said on this thread is the "giving of a time span" doctors know what they have seen happen before but everybody is different and they cannot honestly say that they know.

[thenry]

Unresting death, a whole day nearer now,
Making all thought impossible but how
And where and when I shall myself die.
Arid interrogation: yet the dread
Of dying, and being dead,
Flashes afresh to hold and horrify.