Ethics and Religion Talk: Doctors and Death

Should surgeons, cancer doctors or other high-risk medical specialists be tested and evaluated on how well they deliver bad news? How important is it that they be equipped with the skills to help their patients plan for death? Might it be a better use of medical resources to let them do what they do best, that is, attempt to cure the patient, and let general practitioners or palliative care specialists talk to their patients about dying?

Fred Stella, the Pracharak (Outreach Minister) for the West Michigan Hindu Temple, responds:

Several years ago, my wife and I were at the doorway of my brother’s hospital room speaking to the person in charge of facilitating both body and organ donations. At this point we knew our dear Marco had scant days to live, and wanted his remains to be of ​service. In the midst of the conversation this woman said, “Yeah, we’ve had our eyes on him for a while now.” My wife and I were stunned. Neither of us could think of how to respond to this very insensitive remark. She sounded like a vulture. 

My point is that not only physicians, but all hospital personnel who interact with both patients and families should be trained in empathic listening and compassionate care. Clearly, some people are simply “born” better at these things. And it would make sense that those who are gifted in this area might be the best ones to discuss unpleasant news. But this shouldn’t excuse surgeons and specialists from these tasks entirely. 

Father Kevin Niehoff, O.P., a Dominican priest who serves as Judicial Vicar, Diocese of Grand Rapids, responds:

From the Roman Catholic perspective, death is not something to be feared. Everyone must prepare for the time they are born into eternal life.

In recent years one of my religious brothers was diagnosed with stomach cancer. When the Provincial asked him if he was afraid to die, his response was, “no, I have lived my whole life for this moment.” Perspective is everything!

Bedside manner is something taught to physicians in medical school. Like every human being, some deal with issues better than others. Still, some will address the topic of death with a patient better than others.

I am not sure forcing surgeons, cancer doctors, or other high-risk medical professionals to take an exam will be effective. Sensitivity to medical procedures surrounding palliative care is helpful to all, especially a suffering patient.

Rev. Ray Lanning, a retired minister of the Reformed Presbyterian Church of North America, responds:

I shall leave that matter of how to test or evaluate such interpersonal skills for others to discuss.  But I must urge all who practice the healing arts to reflect deeply on all aspects and implications of what they do. We are not well served by a class of doctors who only treat diseases in the abstract, or treat only symptoms with no interest in the cause of them. If the aim is to treat the whole ​person, then one fact of human life is, sooner or later we must all die. To ignore or deny that fact is to lose touch with reality.

As a pastor I learned firsthand about the limitations of modern medicine. There are many cases for which there is no known treatment or remedy. A physician with integrity should have the courage to tell patients when all remedies have been exhausted and it is time to prepare for death. If he or she cannot assist them in such preparation, at least know where to refer patients for help.

In a bygone day, when a doctor was called out to attend a dying patient, his first stop was at the door of the manse to bring the minister with him. Both stood at the bedside to bring a full range of help to the aid of the dying. The needs of body and soul were addressed and there was no “wall of separation” between medicine and faith. With the advent of hospice care, much more can be done for the dying patient than mere “palliative care,” and in a very different institutional context.

Linda Knieriemen, Senior Pastor at First Presbyterian Church in Holland, responds:

Medical care, in particular that of end of life care requires a team of professionals: medical specialists, general practitioners, nurses, social workers, hospice workers, spiritual leaders, death doulas. While communicating diagnoses and prognoses is a role of surgeons, and medical specialists (who are increasingly being trained in the art of compassion and communication) they need to use their networks wisely, referring those who have just received difficult news to members of the health care team best skilled in helping with processing this news. 

Some persons want to hear bad news in a clear uncomplicated manner, Others expect a softer approach, which by the former would be interpreted as beating around the bush. The recipient of a ‘there’s nothing more can do” message has a right to feel anger, sadness, and anxiety no matter how gently the word is delivered.  I don’t believe there is only one right way. 

Should medical specialists and surgeons  be evaluated on how they deliver bad news? Formally, no. Should all medical professionals have more training in end of life care and communication… YES!  But I’d choose a surgeon skilled with the scalpel than with a golden tongue.