Should I Tell? Discussing Terminal Prognosis

Question: What are the pros and cons of telling someone how long they have to live?

My mother’s oncologist told her she would be dead in six months if she didn’t have chemotherapy. I suggested she not have chemotherapy for the particular type of lung cancer that she had. Chemotherapy would only address symptoms (which were not present) and the side effects outweighed any possible benefit.

Mother followed my advice and lived for 18 months after that conversation BUT when the sixth month came she waited the entire month thinking she was going to die---because the doctor had said she would die in six months. Is there a moral to this story? I’m not sure but it does point to an issue with telling someone specifically how long they have to live.

There are so many dynamics to dying from disease or old age that we cannot possibly be accurate when putting a number on how long someone has to live. The closest we can try to get is months, weeks, days or hours, so beware of numbers.

Now the question arises do you tell a person that they can’t be fixed; that medical professionals can do no more to keep them alive; that at some point, sooner rather than later, that person is going to die? This is a question I am asked frequently, “Should we tell Grandma the doctors can’t fix her?”

We tend to want to protect the people we care about from the harshness of life BUT who are we to presume we know what is best for another person? Isn't an adult entitled to the truth of their experience so that adult can make decisions for themselves as they deem fit? If people are protecting us from the harsh realities of living, who can we trust? Who can we turn to for the truth?

I often ask the family member who is having difficulty with the concept of telling Grandma what the doctors believe, “If it were you in your grandmother’s situation would you want someone deciding what you could or couldn't deal with? Don't you want those closest to you to be the people you can trust to be truthful with you?” As an adult, Grandma has earned the right to make her life and death choices based on real, honest information not someone's ideas of what she should or shouldn’t be told. We can't make the best choices for ourselves if we don't have accurate information. A part of our society's problem is we think we know what is best for others based on our own beliefs.

What are we gaining by denying someone we care about the truth? The struggle? The decline will still occur. The fear of where life is going will still be there. Confusion about why she is declining vs. getting better will present itself although it may not be verbalized to anyone. Because we live inside of our bodies on some level we suspect the truth and eventually that suspicion is confirmed.

By deciding not to tell someone the truth of their prognosis aren’t we denying them the opportunity to put their affairs in order, to say goodbye, to look at life from a different perspective, to prepare themselves?

There are pros and cons to telling a person they can’t be fixed. I've touched on some of them. I don't know the "right" answer. I do know that we will figure it out for ourselves at some point. From there we may continue playing the game and be alone with our fears or we may verbalize our concern.

No one knows exactly when someone is going to die. We can know they are going to die sooner rather than later. We do know that eventually a person will know they are dying whether or not they are told. Once a person knows the truth of their end of life situation, isn’t how to live the best we can until we are no longer living the most important decision that we, the family and friends, can help with?

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