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Accuracy of Terminal Prognosis

Every month, Compassion & Choices Medical Director, Dr. David Grube, answers frequently asked questions about medical aid in dying. 

Q: Isn’t medical aid in dying inappropriate given that prognoses for life expectancy in terminally ill patients can be wrong by months or decades and end-of-life wishes to die can wax and wane?

A: We doctors are much more likely to overestimate our patients’ length of survival than to underestimate. In fact, a study of physicians’ prognostic skills showed that sixty-three percent of us tend to overestimate by 500%.

With cancer, the most common diagnosis among those seeking medical aid in dying, predictions about length of survival are clearer. For many reasons, oncologists, however, are often reluctant to tell patients their disease is not curable. A far greater problem is not informing patients when treatments are no longer likely to have a benefit. According to the National Hospice & Palliative Care Organization, in 2014, nearly half of all hospice patients were enrolled for fewer than 14 days. Similarly, in my experience, most patients request medical aid in dying in the very last days of their life, when the process cannot be accomplished. Clearly, we physicians hold out the hope for patients longer than may be in their own interest.

It is important to remember that medical aid in dying is patient-centered care. The dying individual remains in control and determines if and when to ingest the medication. Of course, if their hospice care allows for them to improve for a time, or if a new and remarkable treatment prolongs their life in a way that they believe isdignified, enjoyable, and tolerable, they can then choose to delay aid in dying, or not opt to employ it. Most recent statistics from Oregon show that approximately 1 out of 3 patients who received a prescription for medication never used it.