It is one of the most difficult healthcare decisions many families will ever face: Should you tell a dying loved that he or she doesn’t have long to live?
For some terminally patients, the grim news can be beneficial and help them prepare, experts say. But for others, the truth can be devastating.
When newspaper advice columnist Abigail Van Buren was ravaged by Alzheimer's disease, her family decided not to tell her about the diagnosis.
"Dear Abby," born Pauline Phillips, died at the age of 94 this past year and her son, Eddie, believes that she instinctively knew she was dying despite the family's silence.
She insisted upon reading the book, "I Love You, Ronnie," a collection of letters between former President Ronald Reagan and his wife, Nancy. In the correspondence, Reagan, an Alzheimer's sufferer, writes to Nancy: "You know it’s a progressive disease and there is no place to go but down, no light at the end of the tunnel."
When Allen Ball, a realtor from Colombia, South Carolina, tried to convince his feisty 94-year-old mom, who had an aggressive brain tumor, that she was getting better, she replied: "Well, I certainly don't feel better so you'd better prepare yourself!”
Gary Small, M.D., director of the UCLA Longevity Center, says being truthful with a dying person is always preferable. The exception is when the news clearly would cause undue suffering.
"In my opinion, patients should be told they have a terminal illness unless informing them might be harmful," said Dr. Small, author of The Mind Health Report newsletter. "This maintains their autonomy and ability to plan realistically for the future."
Jack Singer, M.D., a noted psychologist and president of Psychologically Speaking, headquartered in California, acknowledges that this is a delicate matter. "Too often families hide the reality from their relative and placate him or her with comments like, 'You’re going to be fine.' And very often the patient knows differently and wants to deal with reality," he told Newsmax Health.
"These loved ones want to prepare for their passing by getting their affairs in order. They may want to record messages to family members or talk with a member of the clergy about spiritual matters, including what happens to them when they pass."
Dr. Singer points out that when families live in denial, patients never get the chance to express their real emotions, and they never resolve their issues or reach closure with family members before they pass.
"You should always try to understand and empathize with what the patient is saying rather than judging or getting irritated because they are 'giving up' or telling them they are wrong," says Dr. Singer. "The patient needs dignity in being heard and preparing for passing."
Leslie Kernisan, M.D., a San Francisco based geriatrician who writes about aging issues on the website Caring.com, says she also generally recommends that patients be told. But there are exceptions.
"There is no right answer. What you say or don't say depends on the individual and the situation," she notes, adding that there are patients who make it clear they don't want to be told about a terrible diagnosis.
For children with terminal illness, it's also a case-by-case evaluation, depending on the age and maturity of the child, says Dr. Singer.
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