Training Doctors to Talk About Death
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By Jerry Balentine
When Kara Tippetts, a 38-year-old mother of four, died of breast cancer
last year, more than 17,000 people live-streamed her funeral. Tippetts
gained national prominence through her blog, where she confronted her
impending death with a refreshingly frank take on living with a terminal
Unfortunately, Tippetts' openness is usually missing where it's needed
most: hospitals. Medical caregivers are often reluctant to discuss
end-of-life plans with terminal patients. Death is considered a taboo
topic, until after a patient has passed. This lack of communication
frequently leads to degraded care and needless suffering.
One recent survey of patients with advanced cancers found that only 5
percent knew their projected life expectancy was just a few more months.
Another found that only half of patients with renal and pulmonary
conditions had been offered consultations on palliative care.
Denied understanding their situation, patients often seek invasive
treatments with torturous side effects. Over 70 percent of patients with
incurable colorectal, breast, lung, pancreatic and prostate cancers
pursue aggressive care in their final months.
This collective denial of death can actually harm patients. A JAMA
Internal Medicine study found that since 2010, nearly 70 percent of
cancer drugs were approved without proof that they extended or improved
While cost should never factor into treatment recommendations, the
collective denial of death is financially burdensome for patients and
their families. Families with cancer patients declare bankruptcy three
times more often than other households.
There is no "right" response to a terminal illness. The decision is
personal and based on spiritual, social, financial and emotional needs.
Some patients fight until the end. Others prefer to ease up on care -- or
even die on their own terms -- to focus on quality of life or family
Take Jerika Bolen -- a 14-year-old with Type 2 spinal muscular atrophy, a
terminal genetic condition that causes constant pain.
After her 38th surgery -- and spending 12 hours per day connected to a
ventilator -- the Wisconsin teen decided to end her life. Her final wish?
A prom. So this July, friends and family danced the night away in a
ballroom. Bolen was named prom queen.
Terminal patients can only make these tough choices if their doctors are
able to have hard conversations. Yet fewer than a third of primary care
physicians receive instruction in end-of-life treatment.
Fortunately, some medicals schools have noticed this training gap and are
working to fill it. Stanford's medical school orientation requires a
discussion of the ethics of death. George Washington University Medical
School teaches a course about dying.
Johns Hopkins actually assigns students to write instructions for their
own end-of-life care, which forces them to confront the decisions
terminal patients face.
Here at New York Institute of Technology, our Gold Humanism Honor Society
rewards osteopathic medical students and faculty for tackling challenging
patient care with compassion and tact. Medical lectures include
information on ethics, end-of-life issues and care. Our physician
assistant studies program also includes a ?breaking bad news? scenario in
which students encounter actors role-playing as patients with a terminal
If properly informed, many terminal patients may want to forgo painful
and expensive treatment, choosing quality over quantity for their
remaining days with their doctors and caregivers as compassionate
collaborators. Silencing such discussions fails our terminal patients in
their final need.
Jerry Balentine, D.O., is vice president for medical affairs and global
health at New York Institute of Technology.
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