When I was young, most doctors refused to tell terminal patients that nothing more could be done. They would lose hope, the rationalization went. Anxiety or depression would make them suffer more than ignorance. No one, of course, wants to be the messenger of death or face the slippery slope that candor can evoke—painful discussions of what might have gone wrong, witness to tears and fears, troubling questions about the meaning of life. In my family, such silence resulted in intense misery. A father saying nothing about the tumor that inexorably enervated him; a young mother spinning webs of deceit; a son raging against his enforced ignorance when the truth came out … as it usually does.
Although individual variations persist, things have changed. Today, medicine has discarded the norm of evasion and deceit. As we enter the age of electronic medical records, with access to patient information almost a civil right, it is good to remember that communication patterns change in ways that reflect different community expectations and values.
Read Michael Meltsner’s full editorial here.