What should doctors tell
terminally ill patients?
Invariably, patients ask their
doctors the question, "Am I dying?" What doctors tell patients about
terminal illnesses is determined by the medical doctors' level of judgment, in
conjunction with their professional discretion and the patient's health status.
When the family of a patient
advises a doctor that a patient must not alerted to the reality of his or her
terminal illness, the doctor is then in an ethically challenging position.
Where should the doctor's loyalty lie, with the patient or with the patient's
family? His moral, ethical and legal status could be at stake.
Truth, honesty and integrity
are important aspects of the care, compassion and concern that doctors have and
demonstrate with regard to dying patients. This is also true with respect to
the relationship between dying patients and their families.
"Don't put me in that position!" a doctor might suggest to a family member, who asks him or
her not
to tell a terminally ill patient the truth about his or her illness.
At the same time, patients do
have the right to know that they are dying. There are often important personal
issues or concerns that dying patients need to deal with, when death is
pending. For example, there may be power of attorney papers or wills that must
be signed, estate settlements that need to be made, financial arrangements to
be taken care of, with regard to dependents or personal property and business
details to be dealt with.
Who will become the dying
patient's beneficiary? Who is going to handle the patient's personal affairs,
after he or she passes away? The patient should be involved in the decision
making process whenever possible, as this part of a patient's responsibility
for him or herself, as well as where other family members, friends or business
associates are concerned.
Honoring a patient's request
regarding the truth about disclosure of his or her terminal illness is part of
a doctor's moral, ethical and legal responsibility. At the same time, when the
family becomes involved, there is a larger picture and family members must be
included in the decision-making process. Sometimes a lawyer's participation is
necessary.
There may be serious concerns
about the mental status of the patient, as well as his or her health. In this
kind of a situation, the doctor and family may have to make the decision about
whether the patient should know that he or she is terminally ill.
Is the patient able to
understand the reality of his or her medical prognosis? Does the patient
comprehend the significance of a diagnosis with a terminal illness? Is the
patient confused or disoriented? Will knowing his or her health and mental
status change the status of the patient for the better or for worse? Can the
patient accept his or her diagnosis, even if he or she is informed? At times,
it may be better for the doctor, as well as the family to wait and tell a
patient the truth, at a later time or date.
Another option that the doctor
has is to relegate the full responsibility of disclosure to members of the
family. He or she may suggest "As family members, you may tell the patient
that he is not expected to live."
Ideally, this may not
necessarily be the best option, as patients prefer to learn about their medical
status from their doctors, rather than from family members, who may distort
facts and miss important details. There may be strong emotions or awkward
circumstances that enter into the picture. A doctor can avoid potential moral,
ethical and legal problems by allowing the family to tell the patient the truth
about his or her terminal illness, when he or she is present to answer any of the
questions that the dying patient may have.
Sometimes dying patients have
no questions at all; they just resign themselves to their fate. Others will
bombard doctors and family members with all of the possible treatment options.
Some may request immediate spiritual counseling or guidance. Patients may
become angry or upset and go through various stages of denial, resignation and
grief with regard to the prognosis of impending death.
Denial is only one way of
dealing with terminal illness. Sometimes, there is immediate acceptance by the
patient who states, "I have lived a full life." Some patients become
frightened and try to run away mentally, emotionally, physically or
spiritually. Other patients may choose to seek the comfort of family members or
others.
Sometimes patients prefer not
to know that they are dying and may request that their doctors do not tell them
the truth. Others already know or sense that they are dying and may become
angry when the doctor and family members try to hide the truth from them. Dying
patients sometimes find out from others that they are dying. This can be
extremely upsetting to them. They may ask, "Why did I have to learn this
from someone else? You are my doctor. Why did you not tell me?"
At times, patients want to
request a do not resuscitate order from their doctors, in order to avoid
prolonging inevitable death or having to go through life-sustaining
measures.
Should a doctor tell a patient
when he or she has a terminal illness, if the family requests otherwise? Again,
one must suggest that this decision is at the discretion and judgment of the
doctor. What should doctors tell terminally ill patients that they are dying?
Initially, this should be between the doctor and his or her patient. In a
critical medical situation, family members or others may need to become
involved immediately, as well.
Sometimes, timing is everything.
Note that each situation is
different and unique, in its own way. There is never an easy way for any doctor
or family members to tell a patient that he or she has a terminal illness, but
love finds a way.
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