End-of-Life Choice, Palliative Care and Counseling

Posts Taggedcancer

Why Can’t Doctors Tell Cancer Patients the Truth?

by Mary Elizabeth Williams
Salon
January 11, 2013

Everyone appreciates a bright perspective, especially in grim circumstances. But you know what’s a really poor arena for downplaying the bad news? Medicine.

A new report in the Annals of Oncology this week reveals that in two thirds of breast cancer studies, side effects were downplayed – including serious ones. And, as Reuters reports, it’s a field-wide problem in the health care industry: Last fall, cardiology journal editors warned authors to “watch their language” in reporting, and pediatrics researchers warned of “spin and boasting” in their journals.

Aside from the ethical issues of publishing misleading information, the habit of rushing to make it all seem better has serious consequences. Because the sunnyside talk doesn’t stop at the journals. It trickles over to doctors, who then minimize what a patient’s real experience is going to be like. More

Dying of Cancer, Fritz Behr Refuses Radiation, Stops Eating, Has No Regrets

by Sanjay Talwani
Independent Record
November 27, 2012

A man on his deathbed smells delicious chocolate-chip cookies baking. He makes it out of bed and crawls downstairs to the kitchen, where he sees the cookies cooling on the table.

He reaches up for one, only to have his wife smack his hand away.

“Don’t touch them!” she says. “They’re for your funeral!”

That’s one of many jokes Fritz Behr has told Dr. Justin Thomas at the St. Peter’s Hospital Cancer Treatment Center lately. Behr visits the oncologist on Tuesdays, and has promised to bring two jokes with him at each appointment.

“It’s like ‘Tuesdays with Fritzie,’” Behr said, alluding to “Tuesdays With Morrie: An Old Man, a Young Man, and Life’s Greatest Lesson,” a 1997 book about a young man’s visits with his dying former college professor.

Behr, 79, has a big repertoire of jokes and also has stage four cancer. A tumor was removed from the back of his tongue about a year ago and he refused follow-up radiation therapy.

About 36 days ago, he decided not to eat, which he could do only with great difficulty anyway.

Now he spends his days at home, with plenty of visitors. He said he feels no hunger or pain, although he smells food and sometimes dreams of it.

“I got no regrets,” he said. “I’m as happy as a clam.” More

Advance Care Planning Affects the Smallest and Biggest Decisions

by Mary F. Mulcahy
Huffington Post
November 14, 2012

Jane has voted in every election since she was 18. Now 33, she’s disappointed that she missed heading to the polls for the first time last week. But Jane has a lot of things to be disappointed about. She knows she is going to die soon. She knows that she will not survive long enough to see the benefits or consequences of her vote. So in the company of less than 60 percent of age-eligible voters in America who exercise their right, why did Jane want to cast her ballot? She votes to fulfill her civic duty. She votes because she believes her vote makes a difference. She votes to impact her daughter’s life. She votes to maintain some normalcy in her own life.

Jane was diagnosed with liver cancer at the age of 31 — a rare occurrence in someone so young and with no underlying disease. She had surgery, but her cancer returned. Since then, she has undergone other operations and has pursued standard and experimental therapies. She has exhausted every medical option available, and now Jane has changed her focus toward creating memories and a secure life for her 1-year-old daughter.

When her cancer returned, Jane and I had a difficult discussion about her future through the process of advance care planning. We identified personal goals and values that defined her own acceptable quality of life. We identified the characteristics and features that define her self-worth. Jane is a single mother, a teacher, a daughter, a sister, a member of her community.

As a single mother, Jane recognized that her daughter’s well-being was to be the focus of what life she has left. Certainly, she dreams of watching her daughter grow up, attending her graduation, and seeing her grow into an independent woman. Despite Jane’s own young age, she is able to realize that death is inevitable, and she has taken steps to control what she can. More

Massachusetts Vote May Change How the Nation Dies

by Lewis M. Cohen
Slate
October 29, 2012

This Election Day, Massachusetts is poised to approve the Death With Dignity Act. “Death with dignity” is a modernized, sanitized, politically palatable term that replaces the now-antiquated expression “physician-assisted suicide.” Four polls conducted in the past couple of months have shown strong support for the ballot question, although a well-funded media blitz by the opposition is kicking in during the final several weeks and may influence voter opinions.

Oregon’s Death With Dignity Act has been in effect for the past 14 years, and the state of Washington followed suit with a similar law in 2008. Despite concerns of skeptics, the sky has not fallen; civilization in the Northwest remains intact; the poor, disenfranchised, elderly, and vulnerable have not been victimized; and Oregon has become a leader in the provision of excellent palliative medicine services.

But the Massachusetts ballot question has the potential to turn death with dignity from a legislative experiment into the new national norm. The state is the home of America’s leading medical publication (the New England Journal of Medicine), hospital (Massachusetts General), and four medical schools (Harvard, Boston University, University of Massachusetts, and Tufts).  Passage of the law would represent a crucial milestone for the death with dignity movement, especially since 42 percent of the state is Catholic and the church hierarchy vehemently opposes assisted dying. Vermont and New Jersey are already entertaining similar legislature, and if the act passes in Massachusetts, other states that have previously had unsuccessful campaigns will certainly be emboldened to revisit this subject. More

A Method for Dying With Dignity

by Marcia Angell
The Boston Globe
September 29, 2012

On Nov. 6, Massachusetts voters will decide whether physicians may provide a dying patient, whose suffering has become unbearable, with medication to bring about an earlier, more peaceful death if the patient chooses and the physician agrees. On the ballot will be a Death with Dignity Act — Question 2 — that is virtually identical to the law that has been in effect in Oregon for nearly 15 years.

Good palliative care is adequate for the great majority of dying patients, but not all. Most pain can be eased, but other symptoms are harder to deal with — weakness, loss of control of bodily functions, shortness of breath, and nausea — and the drugs to treat these symptoms often produce unacceptable side effects. Even worse for many dying patients is the existential suffering. They know their condition is inexorably downhill, and they find it meaningless to soldier on.

This is not a matter of life versus death, but about the timing and manner of an inevitable death. That is why many prefer the term “physician-assisted dying” to “physician-assisted suicide.” In the usual suicide someone with a normal life expectancy chooses death over life. Terminally ill patients don’t have that choice. More