To Die Beneath an Open Sky

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I read the essay by Chandrakanth Are, MBBS, FRCS, FACS, published recently in The ASCO Post and found it both thoughtful and compelling (“A Great Privilege to Die Beneath an Open Sky,” The ASCO Post, September 15, 2013, page 1). Dr. Are made one statement with which I take exception, however, and that is that “no prior discussions had been held with the patient or the family to determine the appropriate course of action in emergency situations.”

As a practicing oncologist, I have found that many patients and family members do not recall these difficult conversations, or may only recall portions of conversations about prognosis. There is research that suggests even after very frank, open discussions, patients’ beliefs are not always concordant with the information that they have been provided.

There is a pejorative sentiment that seems to be increasingly rampant in the medical community, which is that medical oncologists don’t talk to their patients, or that they don’t provide their patients with truthful prognostic information. Dr. Are himself indicates that even after he explained the futility of his intervention, the patient and his family still wanted “everything done.” To me, this means that the patient and his family may have been listening to Dr. Are and his team, but they were not hearing the information. ■

—Elizabeth D. Simmons, MD
Bellflower, California




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