I applaud The ASCO Post for continuing to raise awareness about futile medical care at the close of life with the recent publication of a commentary by Dr. Chandrakanth Are (“A Great Privilege to Die Beneath an Open Sky,” The ASCO Post, September 15, 2013, page 1).
I would suggest, however, that we should neither use the phrase “nothing can be done,” nor teach this to younger physicians. As much as I agree with Dr. Are that it is harder and more time-consuming not to operate or not to prescribe a drug, the phrase “do nothing” is devastating to patients and their families.
Instead, the approach I suggest needs to be taught to young physicians and explained to patients and their families is that “given the circumstances, we are changing the course of care.” This means that a time has come when the patient is too weak to tolerate additional chemotherapy, surgery, or radiation treatment, and we would propose instituting aggressive palliative measures to relieve his or her symptoms. We hope to stabilize the condition and not to make things worse. We are doing something. We are not walking away and abandoning the patient. Something can be done and will be done.
In my years of my personal experience as a medical oncologist, the patients and families almost always accept such an approach. This approach also keeps some hope alive that if (miraculously) the patient becomes better, stronger, and capable of receiving another round of active treatment, that it will be considered. As time passes, patients and their families may start to let go and appreciate the palliative measures being instituted.
“Doing nothing” is not an option. Something always can be done, even if doing something means sitting by the side of a patient and holding his hand. ■
—Khalid Rehman, MD, FACP
New York, New York