Should a doctor tell someone they have terminal cancer?

Kermit.de.frog

I have a dear friend told their life is over within 6 months. This person and their family are now preparing for this in their own way. This friend is very disturbed about it. Of course they are. This person was told without being asked whether they wanted to know.

Is it right for anyone to tell someone they will be dead in such a time frame?

Non terminal, treatable cancer I understand. However is it not the case that this psychologically harms the victim far more?

Would it not be better to simply not tell them?

Or do you believe - "their body, right to know", which I understand too.

I would have thought doctors by default should give out a diagnosis and a prognosis. And if there's to be a change in that, it should almost be up to the patient to signal that they don't want to know. Which would be understandable.

BenedrylPete

What if this uninformed person goes on to organize important business/events...or postpone seeing loved ones for example.
Maybe he/she is the main breadwinner and takes out some joint finacial action that the other cant pay or understand while under the impression of being in good health.
The docs just made things harder.
Medical council would blast them with urea.

Edward Hopper

This sounds trite or dismissive of your question op, its certainly not meant to but How would a doctor phrase " Do you want me to tell you if your disease is curable or not?" Very hard, bordering on impossible for the doctor I'd have thought.

Personally I think being told, however long you have left, gives families time to spend it with the person who is dying and for that person to get the mundane and practical things, like will and funeral arrangements sorted.

Besides giving hope (by omission of prognosis), where there is none, seems more cruel than anything to me.

Sorry for what your friend is going through, and those who care about him.

mynameis905

Sorry to hear about your friend. Yes, the terminally ill should be given a prognosis so that they can put their affairs in order, say goodbye and do anything that they really want to before the end. I think that not telling them would be far crueler. Hopefully your friend was referred to a counselor and has a good medical team so that he or she can pass away in as much dignity and as little pain as possible.

kneemos

The vast majority of people would prefer to know I reackon,and maybe your friend as well when he comes to terms with it.
You get to put things right and spend your last days wisely . It's a bit of a gift in fairness.

theteal

I can't think of a single reason why I wouldn't want to know. Sure, it's sh!tty news to get and it would have a huge psychological impact but it's unavoidable. At least then you have the chance to take charge of the situation, make plans, visit loved ones, spend savings, travel the world (health permitting obviously) etc.

gothic_doll

Strange thread idea...

There are a lot of things to be put into action when someone finds out. Within the family, there might have a wedding or other event to make sure the person doesn't miss it.
A will can be made.
They can make contact with everyone they need to and say what they wish to. They can do the things they might have been putting off.

To withhold the information is denying the person their right to prepare.

Conor Bourke

Imagine knowing you're ill but not being allowed to know it's terminal, watching your own body fail and fade, feeling symptoms but not knowing the cause. Imagine being reassured by people that you'll get better but feeling and knowing in your body that they're not telling you the truth. Imagine not being allowed to ask questions of doctors or nurses, or asking them questions, wanting answers but they won't give them to you. Imagine having things you want to do, people you want to talk to, plans you'd like to make before you die but you can't because you don't know that you're actually dying on your feet.

It's one thing entirely if you're told that you're very seriously ill and you choose not to ask or be told about the prognosis. (Sometimes I think that can actually be quite healthy as you can focus on living for as long as possible rather than fixating on a looming prophesy of your inevitable demise) but it is another thing entirely to want to know the truth about your illness and to have that kept from you.

Avatar MIA

It will obviously become evident in time and they'll wonder if they could have been told sooner.

Some doctors might be reluctant to tell for litigation purposes.

****ty situation OP, but anger best not directed towards the messenger.

Conor Bourke

Edward Hopper wrote: »

This sounds trite or dismissive of your question op, its certainly not meant to but How would a doctor phrase " Do you want me to tell you if your disease is curable or not?" Very hard, bordering on impossible for the doctor I'd have thought.

It is pretty much impossible to say with too much accuracy how long somebody might have left, however with a combination of a relatively clear clinical picture and enough experience, a practitioner can roughly prognosticate reasonably well. I think there's been some research published lately though to say that doctors tend to be very conservative when giving a patient their prognosis at time of diagnosis and the patient often outlives that which can bring a whole other set of challenges but that's another story for another day.

In terms of your question of how does a doctor separate the prognosis from the diagnosis, it can be done but again it's a skill that comes with experience and it takes a lot of discretion. Doctors are supposed to be trained in how to break bad news like this and to be fair, I think they're getting better at it.

Usually the doctor will tell the patient that they have x illness, outline to them the stage it's at and discuss/explore treatment options (if there are any available). At this point, they may then lead on to prognosis but if the patient would rather not know, they can stop them there.

Irish Steve

There are rare and exceptional situations where the medics get a diagnosis wrong, and what is expected to be terminal turns out not to be so.

The most significant example I can think of right now is not a cancer sufferer, Stephen Hawking, who in his early 20's was given a life expectancy of 2 years due to his developing a variant of Motor Neurone Disease. He is now 72, and while severely disabled by the condition, he is still alive, and has made a massive contribution to his specialist field of research during his lifetime.

None of us can know or understand the mental processes that a person goes through when they are told they have a cancer, and even if treatment is possible, at the time, there are no guarantees even if the treatment is accepted, we can't tell what the outcome will be.

I know, I've been there, but that was 13 years ago, and now, with no detectable signs of a recurrence, it looks like I was very fortunate to have caught the issue (Prostate Cancer) before it got to be life threatening in the short term, which it can, and often without symptoms.

I asked the hard questions at the time, and did the research into what I was facing in to, which wasn't a particularly easy thing to do, and it wasn't particularly encouraging, in that 13 years ago, there were fewer treatment options, and some of those options were not simple or quick surgery, with an uncertain outcome that was not dependent on the skill of the surgeon.

Different personality types have different ways of facing complex issues, if a person doesn't want to know what's affecting them, then they shouldn't be forced to have to face it at that time, but the other side of that coin is that the doctors have to try and at least make it clear to the patient that they are facing life changing circumstances in a way that makes it clear that they can't ignore what's happening to them, the potential for making inappropriate decisions in the absence of what may be critical information is just too large.

Benteke

Of course they should tell them, As hard as it is they need to protect themselves, 6 months down the line the patient dies and the family will be in uproar that the doctor did not know and they're then in the firing line

kneemos

Ethically,morally and legally it's the only option.

The Raptor

I'd like to know, so I can do things I've always wanted without a care in the world.

I was too scared to ring my gp back once, for blood results in case I had something. I didn't want to know.

So its hard to say unless I'm in that position.

Fleawuss

Strange idea that a patient isn't entitled to knowledge of their condition, treatment and prognosis. Actually it's a very strange idea.

NIMAN

I find this a strange question.

Any doctor who wouldn't tell you should be struck off imho.

RobertKK

Yes, but we should all be prepared for death anyway. Being healthy or young doesn't mean you will be alive tomorrow.
We all presume we won't be that person who will be dead tomorrow or the next few months or whatever, we all think we will die when we are old, but no one knows and we are mostly pragmatic about it.
Death is something that just has to be accepted as a part of life, one can't avoid it. If you have a known specific time frame to live, one should be told so they can do something maybe they always wanted to do, or at least be prepared to die. It would be worse if the information was withheld and you get told just before maybe a week or a few days before you die, when it could have been managed much better.

Conor Bourke

Fleawuss wrote: »

Strange idea that a patient isn't entitled to knowledge of their condition, treatment and prognosis. Actually it's a very strange idea.

I wholeheartedly agree, but there is a surprising number of people out there who believe that their loved one shouldn't know that they're terminally ill or in receipt of palliative care.

Ash.J.Williams

Give it to me straight...life is short

Sound Bite

Absolutely....why ever not?

Ash.J.Williams

The manager told RollingStone.com that Lemmy reacted calmly. "He took it better than all of us," he said. "His only comment was, 'Oh, only two months, huh?' The doctor goes, 'Yeah, Lem, I don't want to bull**** you. It's bad, and there's nothing anyone can do. I would be lying to you if I told you there was a chance.'"

Fleawuss

Loop Zoop wrote: »

I wholeheartedly agree, but there is a surprising number of people out there who believe that their loved one shouldn't know that they're terminally ill or in receipt of palliative care.

So what? It would be utter idiocy of them to try to make their beliefs prevail. Box in the teeth idiocy.

blade1

Ash.J.Williams wrote: »

The manager told RollingStone.com that Lemmy reacted calmly. "He took it better than all of us," he said. "His only comment was, 'Oh, only two months, huh?' The doctor goes, 'Yeah, Lem, I don't want to bull**** you. It's bad, and there's nothing anyone can do. I would be lying to you if I told you there was a chance.'"

My fathers death was pretty much the same.
On the 22/12/2010 he was told he had cancer.
He died 2 days later on Christmas Eve

To be honest I was glad in a way that it was only 2 days as he didn't have to suffer for too long.
He walked into hospital and from the moment he was told there was nothing they could do he almost disintegrated before our eyes.

Unbearable to see him suffering but got to say some stuff to him that I should have told him all my life before he died.

Conor Bourke

Fleawuss wrote: »

So what? It would be utter idiocy of them to try to make their beliefs prevail. Box in the teeth idiocy.

AH answer: Absolutely! Fvck them, how dare they be so stupid.

Real life answer: It doesn't quite work like that if you're the doctor or nurse who's being obstructed from doing their job. You have a duty of care to the patient but you have to be sensitive and tactful In dealing with their family too and it usually takes a lot of work with the person who is doing the obstructing. Usually the persons intentions are good, if misguided and it's a measure of their own distress as opposed to the patients.

It wasn't me!

My grandfather had terminal prostate cancer when he died (He had a stroke that killed him then). He wasn't at the point of receiving palliative care quite yet but the family had had a conference to decide not to tell him about his condition or his prognosis, so he would have died the only person in the room not to know what was happening to him. To this day, that thought makes me shudder, and to be honest, it was something of a turning point in my life in terms of my ability to have faith in well-meaning people.

Fleawuss

Loop Zoop wrote: »

AH answer: Absolutely! Fvck them, how dare they be so stupid.

Real life answer: It doesn't quite work like that if you're the doctor or nurse who's being obstructed from doing their job. You have a duty of care to the patient but you have to be sensitive and tactful In dealing with their family too and it usually takes a lot of work with the person who is doing the obstructing. Usually the persons intentions are good, if misguided and it's a measure of their own distress as opposed to the patients.

Utter bilge. A group of people being entertained in interference in the patient Doctor relationship? Time being spent "managing" their obstructin? Real world answer is that if you know any doctors with holding information from a patient on such a basis is that you report them to the medical council.

NIMAN

blade1 wrote: »

My fathers death was pretty much the same.
On the 22/12/2010 he was told he had cancer.
He died 2 days later on Christmas Eve

To be honest I was glad in a way that it was only 2 days as he didn't have to suffer for too long.
He walked into hospital and from the moment he was told there was nothing they could do he almost disintegrated before our eyes.

Unbearable to see him suffering but got to say some stuff to him that I should have told him all my life before he died.

Sorry to hear that Blade1, but I hope you don't mind if I ask if your father was in pain, or what made him speak to the medical people on the 22nd?

When I heard the Lemmy story I was wondering how someone coul dhave cancer so serious and only be seeing a doctor 2 days before it was serious enough to kill them.

My own aunt died from leukemia 3 weeks after she was diagnosed, and I thought that was incredibly quick for disease acceleration.

darkpagandeath

yes....

sunbeam

My father didn't want to know twenty years ago. He just couldn't handle having an expiry date placed on his life. This made things harder for us as the doctors were pretty vague with us about what the prognosis was. They told my mother they couldn't cure him but could keep him alive for 'a long time'. She was of the generation that didn't question doctors so asked no more about it. Those were pre-internet days and I resorted to reading medical text books in the college library, all of which spoke in terms of five year survival rates.

The 'long time' turned out to be seven months. My father never openly acknowledged he was dying but two weeks before he died, when he was still relatively well, turned around to my mother and outlined detailed plans for his funeral.

I my case I think I would definitely want to know.

Menas

I think that some people may get a certain 'peace' from knowing when they will die. I think I would.
Knowing when you are going to die allows you to get things in order, make arrangements, talk properly to those you love etc.

I would prefer to know when I am going to die. No doubt.