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Views & Reviews Review of the Week

Are doctors heartless about death?

BMJ 2008; 336 doi: (Published 10 April 2008) Cite this as: BMJ 2008;336:835
  1. Jerome P Kassirer, distinguished professor, Tufts University School of Medicine, Boston, Massachusetts
  1. JPKassirer{at}

    Do doctors neglect death and the dying, choosing instead to focus on flogging the last bit of life back into patients? Jerome Kassirer looks at a new book on the subject

    The litany of charges against American doctors is familiar. In our zeal to defeat disease we go too far. We don’t know when to give up, and consequently we lose sight of our fundamental responsibility, namely the best interest of our patients. We put people through too many tests. We treat their diseases long after the chance of cure has dissipated. And when the end nears, we avoid or abandon them. We don’t talk to them about options at the end of life. We don’t even use the word death.

    Are doctors truly that heartless? Have the rigours of medical school, training, and practice inured us to suffering and sealed us off from our patients’ real needs? Grievances such as these, however, often ignore the uncertainties of clinical medicine, the uniqueness of each patient, and the enormous differences in the personalities and nature of practitioners. Doctors don’t want to overtest or overtreat. They don’t want to end up flogging the last bit of life back into their dying patients. Yet to deny that we view our mission as one …

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