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The facts of death
  1. John Launer
  1. Dr John Launer, London Department of Postgraduate Medical Education, Stewart House, 32 Russell Square, London WC1B 5DN, UK; jlauner{at}londondeanery.ac.uk

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I have lost two friends to pancreatic cancer in the past few months. Two other friends are in the middle of cancer treatment and unsure what the outcome will be for them. From all these friends, and from many others who have had cancer in the past, I have heard the same stories. Their medical care has been excellent in technical terms, but on a personal level it is stony cold. However often we remark on the fact, it still remains true that doctors are mostly not good about death and dying. Although death is the sole certainty for every patient that we see, and very few people will die without a doctor in attendance during their final days, we still treat the whole business as if it is an aberration, a failure, or something that doesn’t really belong to medicine at all.

SPEAKING THE TRUTH

In cancer clinics and on the wards, the ethos still appears to be efficient at best, or defensive and avoidant at worst. Different members of the medical teams come and go, often without any introduction or explanation of their role in the system. Each doctor delivers a partial message—a test result, or a new treatment option—but no-one appears to hold the whole case together. Nobody, least of all the senior consultants, ever seems to sit down and take time to speak the truths that really matter: “You may die”, “Our treatment may delay your death but it cannot prevent it”, “I’m sorry but our treatment hasn’t worked”. It doesn’t matter whether patients are attending district hospitals or major teaching centres, or even whether they …

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