Callous doctors?

[cornflakecrunchie]

Why do they tell (especially older people) nowadays that they're going to die? Would you want to know? I certainly wouldn't. I can't understand why they aren't 'treated' with some placebo.. the power of the human mind would otherwise see them off faster, or maybe that's what's wanted these days?
The (two) people that I know of are just sitting at home now, wondering if the next symptom means The End.

I think too many people patronise the elderly and make decisions for/about them. I would like honesty, that way I can choose what to do with the rest of my life - no matter how short - and make sure others know my wishes.

I’m a doctor and I regularly tell people they are dying.

Doctors who do not have the clinical skill to recognise this or the balls to have a discussion rob their patients of precious time with their loved ones. They deny their patients agency in the manner and circumstances of their passing.

I often recall with gratitude the doctors who told me my parent and sibling were dying. They did it well; I trained for years to do the same.

Fearing death and pretending it doesn’t exist doesn’t change it, nor does it make it easier to bear.

I'm old enough to remember a time when people often weren't told. I thought it was wrong then, and still do. People have the right to be given the facts about their own health.

If you think hospitals are comfortable you havent been to one for a long time. My dictor daughter has to tell people when they are very sick and may die. She then works hard to make sure they use the time they have left the way they want.

That may mean getting them home or finding them a more private part of the ward or getting their dog onto visit.

Often the people who struggle most with knowing are the friends and family. If someone is at home waiting to die lets make their remaining time as good as possible.

Well, that's your choice, so you have to live with that choice. Most sensible people would rather be made comfortable in hospital.

So what do you propose? That the default is to lie to people because some might be upset. If you are the type that doesn’t want to know, then tell the medical professionals concerned that you don’t want to know. For some knowing the end is nigh is comforting, it brings a sense of focus.

Doctors not telling their patients the truth, is unethical.

You're being a bit ridiculous, OP.

Everyone dies. That's literally the only thing that is guaranteed about your future from the second you enter the world.

My dad died 12 years ago. No one at the hospital made this clear to my family and I don't really understand why. None of the doctors mentioned end of life care or even that death was a possibility. I can only think they just assumed it would have been obvious.

His wife and my brother were talking about arranging respite care when he was discharged and thought my then husband and I were heartless for wanting to discuss the fact that he wasn't being discharged on this occasion.

The upshot was, my then husband and I visited him on the day he died. My brother and my dad's wife didn't and just told me they were going to go tomorrow and I was being dramatic for suggesting that they went that day because i didnt think he was going to be here tomorrow. But they didnt go and he died around midnight that night. It was obvious to me. But the possibility of death hadn't actually been mentioned by anyone.

Pussyfooting around the facts is ridiculous.

In fact, this scenario is one I use to explain the difference between 'nice' and 'kind'.

The mechanic analogy on page.one is correct.

I suppose I would still rather know, BUT, as you say, the book needs editing.. I'd like to be told that I could have drugs to help me, say, not be in pain, that my life was still valued.. not that I 'probably wouldn't survive' the next episode.

In that case, that is what you need to to tell them at the time.

I don't want to be told by a medical professsional that my life is still valued. I'd want to know if I was likely to survive another episode.

But then I'm quite pragmatic about death.

Doctors will always be honest with patients. When my dad was dying they were very honest. I guess if someone doesn’t want to know, they can tell the doctor that, but surely it becomes obvious and the nurses who visit will need to speak to the patient about palliative care etc. My dad was asked for his opinion on a few things, and it was important. He signed a DNR and we were very grateful for that, otherwise we would have been told to start CPR when i had ring 999 to tell them we found my dad deceased (died overnight). The ambulance would have had to start CRP, they wanted to see the DNR on arrival. My dad would have killed us if we had brought him back to suffer more. I really think adults need to know so they can make important decisions on their treatment.

I haven’t read the whole thread so maybe I’m missing something. They aren’t callous. They are doing their job. Do you think police officers who go to tell people their son, daughter, wife or husband have been killed are callous too? Instigating those conversations has got to be a very difficult part of those jobs but people need to be told.

I think it was more common years ago (I’m in my 60s for context)

I think having a relative who is terminally ill is bad enough without trying to keep that information from them.

The cases where the person knows but is keeping it from relatives (who know but think the ill person doesn’t) just sound so sad.

And is the ill person not to be told why they can’t go on holiday (because health insurance would have to be involved, but the ill person wouldn’t know)

Fine if someone doesn’t want to know and asks not to be told how serious there illness is.

@Saschka - I am only telling what happened to my dad, and how upset he was. He was told he was DNR and had a panic attack. That he was so afraid in his last days haunt me.

I think there needs to be a holistic approach and that perhaps families could be included so they can discuss how to tell the patient

I am eternally grateful to the GP who saw my mum in the last week of her life and advised us to call the hospice now as she was dying.

We had had one previous GP out who pussy footed around allowing me and my dad to think this was another salvageable crisis (of which there had been many) but this GP told it straight. At first I was shocked and didn't want to believe it but quickly realised she was right and she was being kind.

She allowed us all to get our heads round it, call family to come right away and for her to die peacefully in the hospice (within only 48h of getting there) as per her wishes. That was excellent medicine.

What strikes me about this thread is that there are some older people who seem to have not accepted their own mortality. We are all going to die and it seems very strange (and dysfunctional) to reach your elderly years without accepting this.

I nursed in the days when a doctor would tell the family of their elderly relatives' cancer/terminal diagnosis, then to be told by said relative "don't tell mum she's got cancer, it will kill her"
NOBODY has the right to withhold health ingformation from a patient.
No relative has the right to know such information unless the patient has been given permission to be told (or they have an applicable poa), but even if they do know, they have no power/right to tell healthcare professionals to withold that info.
People have such weird ideas

Is there any need to be so rude ? I remember a time when it was standard practice for doctors not to tell patients they were terminally ill if they deemed it not to be beneficial. They were also bound by the wishes of the family. It’s not ideal and obviously honesty is better, but sometimes, even nowadays it’s not possible or desirable and some circumstances dictate a cautious approach, so you do have to decide where to draw the line.

I don't think it’s unreasonable or infantilising for family to step in if they feel it necessary. There may be reasons unbeknown to the treating doctor as to why it would be unwise, or the family may just know their relatives’ stated wishes where this is concerned. From the other side of the coin, once you tell someone, you can’t untell them so it’s best to have all the information before you say a word.

If a patient has capacity then it is their medical information to do with what they wish. The doctors do not have to speak to family members and indeed can't share information with family without the explicit permission of the patient. It is unethical to withhold information from patients, life and death are hard but we have thankully moved away from the very paternalistic form of health care.
Death is inevitable and if you have reached your 80s/90s then, while very sad for all involved, it is not unexpected.

Watch perfect pub walks, the episode with Alan Davies. His mum died when he was a young boy. Neither she nor the children were told that she was dying. Neither why they allowed to see her and they never got to say goodbye. She never got to tell them how much she loved them. At nearly 60, it still haunts him.

People must be told the truth.

When my elderly relative was told that his condition was terminal he decided to reach out to his estranged brother and the two of them were able to make peace with their past. He made it a point to see old friends and extended family and visited with people while he still felt well enough. He was able to make clear what he wanted for end of life care and we were able to carry out his wishes.

None of that would have been possible if his doctor hadn't been completely honest and truthful with him.

I think it depends on circumstances. My mum has dementia and has had a return of breast cancer which can’t be treated because of her age. I have no intention of telling her because I know it would distress her. Consultant agrees.

Emphasis on the word bliss is I think the OP’s point