the ethics of dying

An acquaintance of mine took offense to a morbid comment I made on a mailing list. I wrote something in rebuttal to his angry reply. The argument leading up to this is unimportant, but I like how I've articulated the medical mindset, and reproduce it here:

I'm sorry if I gave the impression that I don't care about patients, because I do. I want them to live, and I want to do everything in my power to make that happen, and when it can't be done, I want them to be given the dignity they've been accustomed to their whole life. And even though I hate the thought of doing it, I need to be the one to tell them, clearly and as honestly, that they're going to die. Because, goddammit, somebody has to do it.

At this point, I've only had to give 'the talk' to hypothetical patients in role-playing situations, and it's heartrending even then. The worst part, from where I sit, is having to kill any hope the patient has, but it's far, far crueler to leave someone with a false hope that they will get better, than to give them the chance to prepare themselves and have as good and as peaceful a death as is possible. The whole thing is devastating for them, but that's why they teach us to do it as compassionately, as straightforwardly, and as honestly as possible.

Do most doctors crack bad jokes about everything in the business? Of course. But that's because it's the way most deal with the cold reality that, despite the fact that you've dedicated your life and career to saving other people's lives, and no matter how close your relationship with your patients becomes, eventually every single one of them will die and you won't be able to do anything about it. The futility of it all is enough to make anyone nihilistic, unless you keep a sense of humour about it. Morbid and twisted as that is, the alternative is staring mortality directly in the face, every day, for the rest of your life.

The conversation with a terminal patient, however, would involve none of that, because it's my responsibility and my privilege to help them face the end of their life with dignity. We ask them if they'd like a family member there for the diagnosis, because they'll see their family as their source of support and consolation. We explain carefully and straightforwardly what we found, and the implications of those findings, and make sure they understand. And we talk about getting them into palliative care, so they can be at home for as long as possible and be made comfortable and dignified until the end. And I'll spend as long as it takes for them to collect themselves and to let the news sink in, because I do give a shit that they're given the best care possible, if only because I want someone to do the same for me when my time comes.