Doctors Death Talk Dilemma

It is an inevitable fact that man must face. Our finite existence, the ticking of our internal clock; death is a reality that many people don't think about, not to mention even talk about. Yet, doctors have been known to avoid the issue when their patients are terminal. They may continue to offer patients hope rather than straight talk about death. So, are we just not strong enough to face the truth?

An advanced lung cancer patient James Rogers is strong enough. He asked his physician whether his condition could be treated. His oncologist confirmed that he was terminal. Rogers stated, "I like being told what my health condition is. I don't like beating around the bush. We all have to die. I've had a very good life. Death is not something that was fearful to me."

Discussing death with a patient like Rogers is not that difficult. The conversation is direct, the patient wants to know and it alleviates a lot of pressure for doctors who aren't sure when to have the talk with a terminal patient. However, each patient responds differently to hearing that they aren't going to make it. The challenge lies with those patients that continue to deny the reality of their condition and refuse to accept that their body can no longer fight off the disease.

At times the problem is in fact the doctor who will not give up treatments and is not willing to accept that there is nothing more that can be done for a patient. Dr. Otis Brawley, chief medical officer at the American Cancer Society, finds that doctors have difficulty accepting that their patient is dying. Doctors feel like having the death talk means they've failed and the disease won.

A new study was conducted and it had over 600 participants from Connecticut, Massachusetts, New Hampshire and Texas. The study participants were advanced cancer patients with less than a year to live. The study looked at the difference between patient groups that were asked and those that weren't about the kind of end-of-life care they'd like to receive. Interviews were done from the start of the study until their deaths. Over half of the patients enrolled in the study died and for those that had end-of-life talks they were three times less likely to spend their final weeks in an intensive care facility, four times less likely to be hooked up to breathing machines and six times less likely to require resuscitation.

The California Assembly supports the patients' right to know and is convinced that the study has real benefits. That being said, the assembly has passed a bill requiring health care providers to give complete answers to dying patients who ask about their options. The bill is now with the state Senate. While some doctors are against the bill citing that it interferes with the practice of medicine others find their may be a need for it. Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University and president of the American Society of Clinical Oncology stated, "That is distressing if it's true. It says we have a lot of homework to do."

Death is a natural part of life and it is a part of medicine. Doctors may fear that straight talk about death may harm patients and result in depression. Surprisingly, patients that have these talks were not more likely to get depressed than those who had not. There are many benefits associated with doctors discussing end-of-life care with their patients. For Eileen Mulligan, after getting over the news that she had no more good treatment options for her cancer she began making a "buck list." Sometimes getting the talk offers patients an opportunity to express their wishes, get important things done and give everyone time to cope and come to terms with the news. Dying is certain so a good death should be too.

Source: http://www.cnn.com/2008/HEALTH/conditions/06/15/cancer.talk.ap/index.html