Is Truth the Best Medicine for Dying Patients?


To the Editor:

As a retired emergency room nurse, I wish more doctors would give terminal patients realistic information about when they might die, especially if it’s likely to be soon. I’ve seen hundreds of physicians give patients and their families false hope, perhaps to give them comfort. After the loved one had passed, the family feels sadness and regret because they could not prepare — but also shock, anger and betrayal. They feel that the doctors lied to them.

Dr. Daniela J. Lamas writes that she feels guilty that she was truthful with her patient, but she allowed him to make decisions that may have been impossible had he thought he had more time. Gentle honesty is the only decent and respectful thing to do in such situations.

Rachel Brooks
Pawleys Island, S.C.

To the Editor:

My heart ached as I read Dr. Daniela J. Lamas’s humble confession, because I, too, know the pain and shame of entering a patient’s room hellbent on breaking through their “impenetrable denial” with the unvarnished truth, and instead breaking their trust and our relationship.

I humbly offer “3 E’s” that help me put on the brakes. Dr. Lamas was Explicit, and I applaud her sharing the news honestly and precisely, avoiding the temptation to protect the patient (or herself) by euphemizing or avoiding the revelation altogether.

But before the tell, it is vital to Empower patients by asking both what they know, and whether they are open to hearing the serious information we think they deserve. To proceed without assent is accurately received as a violation of their autonomy and personhood.

And if you facilitate an important conversation that provokes the patient’s emotions (intense emotions are to be expected, not avoided!), then you will do right to Empathize by validating their upset, and in Dr. Lamas’s case, offering an apology for crossing a line, uninvited.

Robert Horowitz
Rochester, N.Y.
The writer is a palliative care physician.

To the Editor:

The most important thing I learned in training to become a hospice volunteer was just to be quiet and listen. Listening is a very important skill and it can be learned. Dr. Daniela J. Lamas is regretting now that she did not respect the last wishes of her dying patient. He did not want to hear he was dying, but Dr. Lamas did not listen well. She is regretting that decision now.

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