Dead silence

Christian Century, Nov 6, 2002

DEAD SILENCE: Doctors routinely wrestle with the issue of what to say to terminally ill patients. It especially falls to oncologists, working with cancer patients, to be bearers of bad news. Or not. One study indicates that 40 percent of doctors withhold terminal prognoses from patients if they don't ask for it or if the family requests they not be told; a similar number use euphemisms to keep patients from confronting the truth.

"Traditionally, oncologists are paid to give chemotherapy, not to have long conversations," says Dr. Kathleen Foley, a neuro-oncologist. Until recently, doctors have not received instruction in how to talk with a dying person and the family, according to Dr. Jerome Groopman (New Yorker, October 28). That may be changing, in part because of an increased interest on the part of patients and families in being informed about and involved in end-of-life decisions. But money may also serve as a catalyst: seven separate studies funded by the Robert Wood Johnson Foundation show that palliative care--taking measures to ease the physical and emotional pain of dying--saves money, in contrast to intensive care which uses radical measures to keep patients alive. That reality is getting the attention of hospitals and insurance companies.