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?

[NOX]

No I don't think so, allowing a family to choose what a dying person knows about themselves is dishonest and unfair on the patient. Imagine your family told you you were getting better or going to and then you finally realise that everyone has been lying to you and that you in fact have no time left whatsoever, that's just awful, no matter how upset someone might be at the thought they are shortly finite.

[EDDIE51]

I disagree , I think the family are the best to know if the person would want to know. They should definately be consulted before the doctors say anything.

[Mick-Talbot]

No, that would just cause even more stress.

[China Doll]

I would be furious if my family or significant other knew something about my health that I did not. The only time I think this would possibly be a good idea is if the family member was suffering with dementia already and completely unable to process the information... and even then I'm not sure.

[rockyracoon]

Difficult one this, my nan was terrified of dying, had she known she would probably have had a heart attack, at the very least she'd have spent the rest of her days very depressed and unhappy. Personally, I'd be the same as China, bloody fuming that I'd been lied to.

[gness]

My husband would never discuss his death with me because he found it far too emotional. I would have been furious if the doctors told him he was dying because he couldn't have coped with it despite knowing deep down that he had only a short time to live.
I have everything put in place for my death and the family know exactly what to do. I would want to be told.
This is something that needs talking about with family before it becomes necessary.

[sandyRoe]

There's no easy answer to this. I think it would depend on the patient. Some years ago my old mother had an x-ray which revealed a 'growth' in her lung. She asked the doctor directly was it cancer and he was evasive. He also said that they'd 'keep a watching brief' which meant they were going to do nothing.
She knew, I think, when she was moved to a hospice.

[gness]

It does depend on the person Sandy and the family should know what to do. My husband and my best friend were dying at the same time. He couldn't discuss anything. She and I discussed everything...even down to the shoes I had to wear to her funeral and making me practice a song. I feel she had the better death but it was their way of dealing with it and I had to respect OH's feelings.

[LazyGun]

This is obviously one of the more difficult issues for doctors. It will probably come as no surprise that there has always been, and continues to be, a lot of discussion and debate over the best ways to handle such situations.There are also national and international legal frameworks that medical professionals have to work within, such as the the Data Protection Act and the European Convention on Human Rights.

There are guidelines.
From the guidelines -
"There is some evidence that doctors are failing to inform patients when
they diagnose cancer, particularly in older patients.6,7,8
This is despite
evidence that some patients with malignancy want to know if their illness is
cancer, and others want to know as much as possible about their illness,
often more than a doctor assume they want to know.9,10,11,12"

and also
"........it has been common practice in some areas to give
relatives large amounts of confidential information without the expressed
permission of the patient, and often before the patient themselves are
aware of their condition. This practice ought to stop. While the
ramifications of the Human Rights Act are not entirely clear, practitioners
must make sure they respect the private and family lives of patients."

http://www.dhsspsni.g...breaking_bad_news.pdf

So, unless the patient is considered incompetent by virtue of their disease, their mental acuity, or they are a legal guardian, in my view the patient should always be informed first, and their views respected when it comes to sharing such details with family and friends. To do otherwise is, essentially, patronising............

[Sqad]

If a patient asked if his/her condition was due to a malignancy....I always told the truth.

if the patient didn't ask.....I always made sure that someone in the family knew.

It worked for me for 40 years or more.

[gness]

Maybe Lazygun but I asked OH's consultant to tell me first and the decision whether to tell him or not would be mine. In thirty years I hope I never patronised him but I knew him and loved him and my decision would be based on that. He was a fantastic, strong and brilliant man....but this was one thing he couldn't deal with.

[daffy654]

When I was told 5 years ago that I had around 10 years left (due to lung disease) I took it quite well, my family were more upset than me.

[chrissa1]

I'm sure that the hospital knew my husband was dying for a long time. He was in hospital from just before Xmas until he died on Feb 6th.

Please don't get me wrong, they did everything they could for him with numerous tests and towards the end, he didn't know what was going on. However, I was told that things were going downhill on the Thursday night and he died on the Saturday night in his sleep. Even then I was told he may pull through.

I think I would have liked to have been told sooner so we could have spent more time with him. Just by coincidence his sister was driving up from Surrey to visit him and did see him on the Saturday evening, but I wish I'd been told sooner, as she does.

[nungate]

My father had been complaining of back pain all through the Christmas period of 1978, he went into hospital late January of 1979, at the beginning of February doctors did a biopsy and lung cancer was found, we were told on the Monday that it was terminal and nothing could be done, he died the following Saturday unaware of his condition. He at first did not want to know, then he changed his mind but when doctor came to discuss this with him, Dad changed the subject, he didn't want to know. In a way I'm glad that he didn't linger and he died so quickly, somehow it seemed "cleaner" than a long painful death. It was harder for those of us left behind. I think it's up to the doctors to decide whether or not the patient is up to being told or not.

[woofgang]

As lazygun has said, where there is mental competence, there is no decision to be made.....

I think that the patient should always be told the truth but there are ways and ways of doing it. It should always be done with sensitivity and in a way that the patient can cope with. I kind of agree with sqad (now there's a first ha ha). There will be people who make it very clear to their doctor that they do not want to know but in my experience they are in the minority. For the rest there seems to be a sliding scale from those who want every detail and to be in control of the decision making process through to the folk who, as we have said, really do not want to know.

I think that without making a bald statement about life expectancy, there is a lot that the patient might need to be told which will inform and reassure them but they might not want to ask. I am thinking about stuff like pain relief, travelling, claiming benefits and so on.

Speaking professionally, all but a very few of the relis who have been adamant that the patient should NOT be told have been wrong. Either the patient knew but thought they wouldn't discuss it because the relis couldn't cope, or they insisted on being told and this didn't help the relationship between doctor and patient and patient and relis.

Personally, speaking as a widow, knowing all the facts made it easier for my DH and myself to deal with the situation as well as we could and not waste any of our precious time. Knowledge, even terrible knowledge can help to give control back.
Speaking even more personally, It is MY body, MY life and MY decision and anyone who tries to withold information from me had better be prepared for slow disembowellment.

[gness]

That shows how different we all are Woof. My husband was ill for eleven years but lived every day as if he was going to get better. He didn't want to know how long or how ...his way...his choice. It worked for us whereas his knowing wouldn't. Our situation was a little different but we had a good time up until the moment of death.

[boxtops]

Patient confidentiality doesn't usually allow matters to be discussed with relatives before the patient's been told, these days. I would be deeply upset if my relatives knew something I didn't. I'd rather it was the other way round. I'd need to set my house in order.

[bednobs]

no. There is nothing stopping a doctor asking the patient "do you want to know anything about the course of disease/prognosis" and the patient making a decision for themselves

[Prudie]

We are all different and I think family should be consulted. I'm pretty sure that I couldn't handle such news and would crumple into despair while I was still alive. On the other hand there are those who grasp all the time they have (bucket-list type). I admire them immensely but know I'm not one of them. I'd like my family to be in a position to tell the doctors I don't want to know.

[Mick-Talbot]

I'd like my family to be in a position to tell the doctors I don't want to know.

But how can that work Prudie?
Are your family supposed to pretend everything is ok?