Dr. Scott Berry, a medical oncologist at the University of Toronto, has written an interesting essay in this month’s Journal of Clinical Oncology entitled “Just Say Die.” His point is that doctors are hesitant to use the words “die” or “death” when counselling patients who are in the process of doing exactly that – dying:
Die is a short, simple word. The problem is that I rarely use it when I speak to my dying patients, and I don’t think I’m alone.
According to Dr. Berry, one of the reasons why we eschew the “D” word when talking to patients about their prognosis is to avoid upsetting them with the use of such blunt terms since they are already in distress as it is. Another explanation is that we doctors find it awkward or unpleasant to bring up such bad news, which the author believes is a reflection on the perverted way our society identifies death as a distasteful subject, one that is almost taboo and should be identified with euphemisms. He remarks on other possible explanations:
It is not hard to see why physicians might have trouble talking about death and using the word death; we live in a culture where many physicians and patients may see death as an admission of failure or of giving up.
For the patients we have known for many years and with whom we have developed deep bonds, we may not want to use the word “death” because we are starting to feel our own sense of loss and the beginning our own grieving.
I understand where Dr. Berry is coming from with his request to speak more clearly about dying when counseling the dying, but I have a twist on his advice. First, here is his approach:
It’s time to take the next step in opening up the discussions we have with our dying patients. The next time you must let someone know they are dying, the best way of doing this may be to say, “You are dying.” It’s more than just semantics. Using the word “die” will clarify our conversations with patients and let them know that death doesn’t need to be considered unnatural or a failure.
Telling every patient “You are dying” seems too formulated to me. It pays no respect to the tremendous amount of hard work the patient has put into the mind, into developing and maintaining a hopeful and courageous attitude during his or her illness, an outlook that reduces anguish and perhaps even steels the body to fight on longer than it was meant to. I have seen the power of the mind and heart, and what it can do to support a body infested with cancer, and the results are impressive. I therefore respect the unique spirit that resides within each of us, and when I see this power still shining in a failing host who wants the truth I might just say this:
“Your body is dying, but not your spirit. The fire that blazes within you, that has allowed you to carry on so long with this disease, is still bright. It will not vanish until your body reaches its final breath, and on that day, on the day of your death, the person that inhabited your body will indeed disappear, yet it will live on – in the memories of those who knew and loved you. Such is the power of the human spirit.”