Editorial – Is it Ethically and Morally Correct to Predict to the Patient How Long He or She Has to Live

EDITORIAL NOTE

Aadil S. Chagla,

MS, M Ch (Neurosurgery), IFAANS

Professor of Neurosurgery, Head of Unit II, Department of Neurosurgery, King Edward VII Memorial Hospital, Mumbai, India.

Consultant Neurosurgeon, Breach Candy Hospital, Mumbai, India.

 

Leena S. Chagla,

MS, FRCS

Consultant Surgeon and Head, Department of Breast Surgery, St Helens & Knowsley Teaching Hospital, United Kingdom.

Hon Lecturer, University of Liverpool, United Kingdom.

 

Palliative care practitioners and particularly doctors are often in a difficult position discussing grave diagnosis and poor prognosis in their patients. “Doomed if they do and doomed if they don’t!” Here we look at the pros and cons of predicting prognosis and giving the patient a realistic life expectancy.

In the western world, particularly the United Kingdom, patient autonomy is a strongly held ethical principle.[1] Today the concept of autonomy also includes telling the patient about the diagnosis and prognosis.[2]

Historically in our culture, family and friends have preferred to shield the patient from the truth, often not telling them of their diagnosis of cancer and never discussing the prognosis. Western palliative care practice would challenge that, saying patients have the right to know. They may want to sort out their affairs, say their goodbyes, and fulfill all on their bucket list. So how can we, the medical profession, deny them of this information.

On the other hand, should we be forcing this information upon an already distressed individual or family? How accurate is the prediction and what are its repercussions on the patient and the family?

Consequentialism says that right or wrong depend on the consequences of an act, and that the more good consequences are produced, the better the act. If what the doctor tells the patient is going to benefit patient and the family and more good consequences are produced, then we believe that the doctor is justified in his actions, but he must provide all available facts about the prognosis of the patient to the most responsible caregiver or relative of the patient giving a truly realistic picture. “Honesty is the best policy.” It is however, important to break this information to the patient or the caregiver in a more humane way, rather than a judge who predicts a death sentence to a criminal.

It is the author’s opinion that each patient should be treated individually, and patient choice is paramount.  A patient should be given the opportunity to ask questions about their future and survival at every stage of their illness and if they wish to know their prognosis, an honest discussion should be had giving them as much information as they wish to receive. All verbal information should be confirmed in writing to avoid any chance of misinterpretation.

References

  1. Jensen US, Mooney G. Changing values: Autonomy and paternalism in medicine and health care. In: Jensen US, Mooney G, editors. Changing Values in Medicine and Health Care Decision- Making. Chichester, United Kingdom: John Wiley and Sons; 1990.
  2. Fallowfield LJ, Jenkins VA, Beveridge HA. Truth may hurt but deceit hurts more: Communication in palliative care. Palliat Med. 2002; 16:297–303.