Head To Head

Do patients need to know they are terminally ill? No

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2560 (Published 24 April 2013) Cite this as: BMJ 2013;346:f2560
  1. Leslie J Blackhall, section head
  1. 1Palliative Care, University of Virginia School of Medicine, Charlottesville, VA, USA
  1. LB9X{at}hscmail.mcc.virginia.edu

Emily Collis and Katherine Sleeman (doi:10.1136/bmj.f2589) say that decision making can be ethically sound only with a fully informed patient, but Leslie Blackhall thinks the concept of “terminal illness” is not clearly defined and that prognoses can never be certain

Patients do not need to be told that they are terminally ill. However, this does not mean we should pretend we can cure them of incurable illnesses or that we should withhold prognostic information from those who want it. But insisting on prognostic disclosure to facilitate “patient choice” about end of life care is a failed model for medical decision making that creates more suffering than it relieves.

What does terminal mean?

The choice model has outlived its usefulness for two main reasons. Firstly, disclosing a “terminal” prognosis is impossible because we do not have a clear definition. Even palliative care physicians do not have a universally accepted definition for this, or for related terms such as dying or end of life.1

Does telling someone that they are terminally ill mean telling them how long they have to live (hard to know for any individual)?2 Does it mean telling them that they will eventually die (true for all of us)? Does it mean telling …

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