Facing the End

July/August 2008 Issue | Posted by Father Richard Gill, LC in Spirituality

Question

I am an oncologist and have many
serious cases of people with poor prospects of survival. I agree that it is wrong to lie to patients, but I prefer not to be completely honest with them because being the bearer of bad news is very emotional and unpleasant for us both to deal with. The news causes my patients to become anxious and to give up hope. It also causes stress to their families and friends. So, I find myself having to ask you what so many patients ask me: When should we tell someone that they’re going to die?

Answer

You are right to question your current method. Ask yourself, “am I avoiding what is best for others just to make it less awkward for myself?”

Families are sometimes part of
the problem, because they refuse to deal with the facts. They prefer to live in denial. Only in extraordinary cases should family members keep a negative diagnosis from a gravely ill person.

Patients have a right to be in charge of their own health care. It is a question of their human dignity. So, doctors have a responsibility to be clear and objective with them, even when it is difficult and painful to deal with. If you are evasive, or avoid laying out all the implications, you limit their ability to consider all the alternatives they have. They have the right to come to terms with the reality of their situation. An honest discussion of their possibilities usually requires some discussion of the statistical probabilities.

A person with little or no hope might want to make the decision to forego any aggressive medical treatment and opt, for example, for palliative care. That should be his own personal, informed choice.

You need also to remember the limits of your knowledge. No one can be absolutely certain of the course a disease will take, and you need to be humble and realistic in communicating the probabilities of death and suffering. This itself will not only help you avoid misleading the patient, but also soften the harshness of the bad news.

Remember, too, that the great majority of people are believers in God and an afterlife. It is only fair to let them know their prospects so that they can consider their future and come to terms with meeting God and make their peace with him, however they understand him. This is especially important if the person is a strong believer in God.

Often enough, the knowledge that death is imminent leads to people reconciling with family members and former colleagues. It would be very unjust to withhold information from them that would prevent them from making decisions to make peace with others they have hurt or offended.

In addition, many people need a chance to make financial and other arrangements before they die that will affect their family and loved ones.
Unfortunately many people do not
plan ahead and have their personal
affairs in order, leading to some very
sad and unfair distributions of assets, which is not what the deceased person would have wanted.

Christians need to approach death with a spirit of faith and hope in God and in what he has revealed to us about death and the afterlife. Our faith teaches us to see death as the gateway to our eternal life and the encounter with the Lord.

In our Catholic tradition, we always have prayed for the grace of a “happy death.” That was understood as a death that does not come suddenly but one which can be prepared for and which
allows one time to prepare adequately. This involves settling our earthly affairs in a just way, but also preparing to meet God and face our final judgment. It gives the person the opportunity to repent of his sins and ask forgiveness from God before he dies. It is very important for us to maintain our faith conviction that after death comes judgment and we need to be ready.

That is why the most loving and compassionate thing a family can do for a dying person is to help him prepare for that definitive encounter with God. Make sure they have the chance to get to confession and receive the anointing of the sick.

Naturally, they need to do this with great charity and delicacy. But if we let someone die in ignorance and without an opportunity to reconcile with God, at best we have a misguided sense of compassion. At worst, we are depriving a person of what is most important to his eternal happiness. C

Legionary Father Richard Gill is director

of the Our Lady of Mount Kisco Retreat and

Family Center in Mount Kisco, New York.

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