Doctors debate whether to tell patients they're terminal

Most physicians agree delivering bad news, such as a cancer diagnosis, is never easy. What's less unanimous, however, is how frank physicians should be with patients about how long they may have to live, an issue debated by palliative care specialists in Britain's National Health System in the April 24 British Medical Journal.

The two sides in BMJ's debate seemingly converge on one key rule, according to Los Angeles Times blogger Melissa Healy. She wrote: "Patients whose lives will probably be limited or ended by a disease deserve a forthright explanation of what treatment is available and what it probably would, and would not, accomplish if undertaken. Given that this is a matter of consensus, the difference seems to come down to how forcefully a doctor should press the point when a patient seems unwilling to face the realities of his or her diagnosis."

Nonetheless, on one side, Emily Collis, M.D., and Katherine E. Sleeman, M.D., both palliative care specialists in Britain's National Health System, contended that knowledge is power. "Decision making in terminal illness extends from the medical treatments and supportive care to decisions around advance planning of care, finances, guardianship, power of attorney, and voicing preferences for place of death," they wrote. "Worryingly, such decisions are not always fully informed."

Presenting the counter point of view, Leslie Blackhall,M.D., a palliative care specialist at the University of Virginia School of Medicine, suggested the concept of "terminal illness" is not clearly defined and that prognoses can never be certain. Thus, "the real question is not whether patients should be told that they are 'terminally ill' but how can we provide excellent care to patients with incurable, progressive illnesses?" she wrote.

"Patients do not need to know that they are terminally ill (whatever that means) but what we can and cannot do for them, and what the trajectory of their illness is likely to be. We cannot cure widely metastatic lung cancer, so no one can 'choose' to die from it," wrote Blackhall.

To learn more:
- read the article from the Los Angeles Times
- see the BMJ discussions for and against telling patients they're terminally ill

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