Interesting and far ranging New York Times article here about how doctors deliver (or don't deliver) really bad news to their patients. The featured MD, in the reporter's words, "fires a shot across the bow," saying, "Currently there are no established cures." Then he waits for the response and goes where the patient leads him, either to a frank discussion of medical options or, if the patient resists or avoids the bad news, elsewhere. Breaking through a wall of denial may do more harm than good, and besides, forecasting death is not an exact science. Doctors know percentages, but have no real idea about how long, exactly, patient X will live.
I thought about how different this was than my experience in CPE. The chaplains I worked with deemed denial the original sin, and we all had a lot to be in denial about. So it didn't matter if I turned in a fantastic verbatim of an encounter with a patient. Any exchange, no matter how innocuous, was enough pretext for my supervisors to hammer away at me and everyone else in my group until they found the rotten, stinking fetid swamp that passed for our souls. I carried this model of pastoral care with me into ministry. At times I did get to the heart of the matter, but at other times I'm sure I came across as invasive or overbearing. How sure? I heard back about it from other people!
So maybe it's best to let the river in Egypt run its course. Let sleeping dogs lie. What other hackneyed expressions can I employ?
The trouble is, death is really, really scary, and we all flinch when we come up against it, whether the tumor's in our body, or we're physicians who prefer to speak in medical jargon ("there's a finding" says one doctor in the article). A finding? One would think that Christian hope in the resurrection would help facilitate a more honest conversation, but Jesus himself was a complete mess in the face of his own death. Sweating blood? Death is the last enemy to be destroyed, most likely because it's the biggest and baddest one we face.
According to the article, hospice care in New York is mainly for people on the verge of death. Days, not weeks or months. This is because doctors are reluctant to call in hospice because it's an admission of defeat, but also because palliative care isn't reimbursed as well as other medical treatments. Both patients and providers have a perverse financial interest to pursue futile care rather than hospice. Money talks, even when death's got us tongue-tied. And upping the reimbursement rate leads to demagoguery about "death panels,"which we've all experienced lately.
But look: the choice is not between curing people or killing them. The choice is between aggressive and futile treatment of terminally ill patients, in which the alleged cure is often worse than the disease, or helping the terminally ill live with as much mobility and freedom from pain as possible for the limited amount of time they have.
Posted by: |