Death’s Good Lies, Bad Lies
When doctors diagnosed cancer 40 or more years ago, the “C word” was barely whispered because it was, in effect, a death sentence. Much has changed in American medicine, with marvelous advances in drugs, machinery and procedures. Sadly, not much has changed in Americans’ pained discomfort with the D word, even when whispered.
A recent University of Chicago study indicates that only a minority of doctors honestly tell terminally ill patients how much time they have left. This has moral as well as family and financial implications for a society that prides itself on openness--unless it is inconvenient, in which case fibbing is fine as long as we also ignore the hypocrisy.
We hope that the study by Drs. Elizabeth Lamont and Nicholas Christakis in the Annals of Internal Medicine will ignite discussion among medical professionals who must help patients and families think the issue through. The study revealed that only 37% of 258 Chicago-area doctors surveyed said they would give dying patients their best estimate of remaining life. Fully 40% admitted they’d be intentionally inaccurate, adding significant time to the prognosis.
The compounding implications of perhaps well-meaning lies are stunning--from families postponing farewells too long to misled patients approving expensive, often painful but utterly hopeless treatments, for which doctors and hospitals are, of course, paid by insurance companies underwritten by our premiums. This further fuels Americans’ corrosive cynicism toward once-trusted institutions. We set these folks up as skilled health gods; they enjoy social respect and its perks. But when awful news is inevitable, oh, my, look at the time, they’ve got another appointment. If a deathly ill, helpless person can’t trust a doctor’s word at life’s end, what hope is there for anything?
But wait. America, like young people, tries hard to see a complex Kodacolor world in black and white. There is mystery to life and death, one reason we cry at both ends. Doctors know a lot, including how much they don’t know. They know no guarantees; they see joggers drop dead and goners fully recover. They know too that hope is a delicate herb. Who are doctors, whose Hippocratic oath vows no harm, to crush all hope in the interests of theoretical candor? Especially when many patients don’t listen anyway.
It’s such a tangled web, as intersecting lies inevitably are. As we stumble through such solemn discussions it’s easiest to blame others. One sobering though little-noticed lesson to emerge from the advances of medicine is how much is now known yet how little is truly understood.
