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When the prognosis is dire . . .

Steven E. North, Esq.


It takes some degree of strength for a physician to be candid with a patient’s family when the prognosis is dire. Sharing in a family’s dismay is emotionally exhausting and time consuming. Bad news is not easy to deliver.

The easy way out of course is a vague statement along the lines of, “We can’t tell for sure,” or, “Just hope for the best.” The fact is, though, that it is often useful for patients and their families to have a real sense of the prognosis so they can plan and act accordingly.

In its July 5, 2016 edition, the New York Times noted that doctors have been urged to “talk about the elephant in the room,” especially at the end of life. Of course some patients don’t want to know and certainly they should not be advised if that is their clear position. Others need to know but are afraid to ask. And still others do know but keep silent because the family has.

When a patient or his/her family is disconnected from a prognosis, end-of-life treatment can be worse than it needs to be. Some patients undergo essentially useless tortuous tests and therapy with the unrealistic hope and expectation that they will prolong life, but instead they cause of agonizing distress. Sometimes patients are talked into continued interventional treated by family members who cannot accept a dire prognosis. Sometimes, patients can no longer speak for themselves.

Frank discussions between patients and doctors help promote decisions about end-of life care that best suits the needs and desires of the patient. To optimally plan long-term assistance and not be blindsided by lack of preparation about finances and estate matters, it is often important to have a real realistic assessment of the disease prognosis.

Patients have the right to know the reality of their circumstances in order to evaluate whether it is reasonable to undergo the ordeals of a potential “miracle cure” rather than spend their final days in a peaceful setting.