Medicine: Should the Doctor Tell?

One of medicine’s great arguments rages on the question: Should a physician tell a patient with inoperable cancer the nature of his disease? Doctors reserve the right to make this decision themselves, even when the patient pleads for information. Says one U.S. doctor: “The question ‘Do I have cancer?’ may in reality be a strong plea for a negative answer.”

Many doctors do not tell, arguing that the cancer victim usually realizes his condition anyhow but will not emotionally welcome scientific confirmation. Fortnight ago, in Cancer, an official publication of the American Cancer Society, a Swedish team composed of a psychiatrist, a surgeon and a social worker offered statistical evidence to support the conclusion that telling the patient the truth “need by no means be an overwhelming shock, and may even be of positive value to the patient during the further course of the disease.”

After careful psychiatric examination of 90 inoperable cancer patients at the University of Lund’s department of surgery, the research team decided to tell 38 of the patients the true nature of their illness. Most accepted the news calmly, or had only small doubts about the wisdom of telling. Only five deplored the doctors’ decision to inform them.

Said the report: “To a patient who is about to die, the knowledge that life is to end obviously predominates, but practical problems are not necessarily entirely eclipsed. Many people have so strong a sense of responsibility toward their work and their dependents that inability to fulfill their undertakings and make provision for their families’ needs produces anxiety and worry that overshadow death itself. If such people are allowed time to settle their affairs and provide for their families, they may gain a peace of mind that makes their remaining time a happy one.” Or at least less unhappy.