SHOULD THE DOCTOR TELL?

Wanganui Herald, Volume LIII, Issue 160735, 23 August 1920, Page 5

SHOULD THE DOCTOR TELL?

(By A Physician.) An interesting question in medical ethics was recently raised at an inquest on a man who committed suicide, it was alleged, because of the unfavourable verdict given by a doctor on his chances of life. The facts as stated may or may not have been true; but the question as to how far a doctor is justified in telling his patients the truth about their condition is not one that can be idly dismissed on© way or the other. So many uncertain elements enter into such a situation, that what is generally accepted as truth does not easily emerge. First there is the diagnosis; then the temperament of the patient and the effect that a hopeless decision might have both upon him and the friends who surround him; then the question as to the purpose such an adverse conclusion would serve. There are people, one knows, to whom such a verdict would come as a challenge and a stimulus; there are infinitely more to whom it would make an altogether opposite appeal. And when all is said and done, the doctor’s job is not to foretell death but to preserve and prolong life by every means in his power. “While there’s life there’s hope” is not only true hut an infinitely more serviceable view to take of disease than one lea, optimistic. EXCEPTION AL CIRCUMSTANCES. With that as his general attitude, there may still arise instances where nothing but good would result from a definite expression of opinion on his part as to the chances of life. "Where a patient’s life is obviously in the balance, and important affairs need settlement, it might be advisable for the doctor to state the urgency of the case. Or again, there are people whose whole habit of mind is that of wishing to face every issue clearly and without extenuation. It might materially add to the peace of mind of such a patient to be told the truth about himself, and if the doctor were assured that such was the case, he might be led to express his opinion without qualification. It is impossible to lay down any hard and fast rule in this matter; though, in my opinion, it is always wise, no matter what the doctor’s own clinical opinion may be, to take into account every chance that offers for the expression of a hopeful view. There are, of course, many cases in which, humanly speaking, no hope exists. The expression of such ah opinion, one might almost call it a certainty, should then he governed less by the clinical than by the psychological aspects of the case. ATTITUDE TOWARDS DEATH. It is the common fate of everyone to die, and fear of death is an almost universal emotion. Certain g’heat philosophers in the past have sought to show how illogical is this fear since death is so common an experience, it is interesting to speculate as to the immediate causes of that fear. How does it arise aud against- what is it opposed? A great deal of that fear is obviously due to particular associations. Most people have an instinctive dread of the unknown, aud that undoubtedly plays an important part in their attitude towards death. A good many are worried in their contemplation of death by religious conceptions, others by revolt from the idea of pain and so on. But when all is said and done, I think it will be found that the deep underlying cause- of all the mixed emotions that the idea of death givea rise- to lies in the love of life. This may be conscious or unconscious. Few people in ordinary health are led to contemplate the thought of dying with anything approaching equanimity unless they have convinced themselves that life is a poor thing; that is to say, unless the will to live is either permanently, or for the lime being inoperative. Such a point of view may be the result of a temporary dissatisfaction or revolt from particular circumstances, or be the result of a deepseated f«ssimism. In either case it is not a normal attitude, aud it is- essential to the continuance and well-being of the race that it should not be so. The normal healthy person loves life* and lannot contemplate with indifference its extinction. Thoughts of death axe forced upon him from time to lime when it hanpnw to his friends or acciuaintances. But in the ordinary way it is the last thing about which he thinks vr-rv seriously. THE IRRELEVANCE OF DEATH. It ; s my sincere conviction, a conviction bused upon experience, that death, as it comes to ninety-nine people out of a hundred, is, so far as they art- eone-erned, of no more conscious significance than falling asleep. Most of the fear and apprehension that is felt by the living and healthy towards death is in the long run utterly irrelevant. Death is the natural consequence of certain circumstances. It dees not clash with them. I am speaking, of course, of death in the physical sense, though considered in its metaphysical or spiritual souse, I see no reason, even there, why it should arouse more disturbing ideas than birth does. Both are inevitable aud universal experiences, the one the- beginning the other the end of that particular experience we call life. To some, no doubt, death comes as a great adventure. Such a conception may haply be true. To a good many it comes as sleep comes after toil, as rest and repose. To many it came recently in more violent forms, preceded, no doubt, by apprehension, but oftener by a courageous stoicism. In any case, death, as compared to the emotions that precluded it, was a relatively unimportant thing. The recognition of this fact by everyone, ill or well, the fact that death wiien it comes, is so irrelevant, should go a long way to removing the tear and misgiving which does undoubtedly add at times to the unhappiness of us all.