Up@dawn 2.0

Friday, January 20, 2017

Informing Patients of Their (Sometimes Bleak) Diagnosis/Prognosis

The conversation in class yesterday was a pretty good barometer of the way in which many people in today's age view the idea of whether or not doctors and/or family members should inform patients of their terminal diagnoses. Many people share Nick's sentiment of "I wouldn't want anyone to keep it from me, so I certainly wouldn't keep it from anybody else." However, this has certainly not always been the case, and many people still do quite the opposite.

Sherwin Nuland talks rather extensively about this in How We Die. He informs us that many times doctors will not comprehensively inform the patient of their diagnosis. An example would be a doctor telling a patient that he/she has a serious form cancer, but the doctor would leave out the fact that the test results also indicated that the patient has a 5% chance of survival. The reason doctors and families alike do this, Nuland says, is that many doctors believe that, even with all of the leaps and bounds medical technology has made in the last few decades, hope is still the best medicine the human race has in its arsenal. If you take away a patient's (or even their family's) hope, you may have just removed the best chance the patient has of recovering. And this is a hard stance to contest, as most of us have heard of one case or another about somebody simply hanging on and fighting against all odds to overcome their prognosis, to prove their doctors wrong, and defeat the odds.

So why then, do the apparent majority of us believe that we should tell people their diagnosis, even if it is the worst imaginable, and even if it may actually lower their chance of survival in ways we don't yet quite understand? Because by not educating someone exhaustively on their diagnosis you are taking away their freedom to take control of their affliction in the only way they can: their freedom to choose how they spend their final days, as in Dr. Oliver's case with his father; their freedom to choose how they die, ideally with dignity; and their freedom to take control of their future, which is now much shorter than they could have imagined.

There is certainly a lot more that can be said on this, but I'll stop here as this is essentially Nuland's thesis on this idea, and I thought it seemed pretty relevant given the discussion yesterday. I would love to hear other people's ideas on this, so feel free to leave some comments, even if they disagree (or perhaps preferably if they disagree!)
                                                                  - T-Rex

1 comment:

  1. It seems so cut-and-dried in one way, doesn't it, that to respect a loved one's autonomy is to disclose full diagnostic information without reserve? But we all know something of our loved ones' personal psychologies as well, and so the picture becomes more complicated. We want them to extract as much pleasure and suffer as little pain in their remaining days as possible. We don't want them to fret or worry about things beyond control. Very few of us, though, would say if we were in that situation we'd want to be misinformed or under-informed. Cutting through it all, treating others as we'd wish to be treated (if they've not provided an explicit directive indicating that they want to be treated otherwise) seems the right default.