Shall we Tell a Cancer Patient the Truth?

Abstract

The beauty and perfection of truth are so integral with life that he who propounds a deviation from it assumes the burden of proof as to the right therefor. The crassness of deception in the field of cancer diagnosis can hardly be alleviated by considering the pain to relatives, the difficulty in brooking the emotional upset to the patient at the time of telling, or the fact that by making so definite a diagnosis the physician has lost the protection to himself of equivocation—none of these reasons, which, I believe, are the cause of much deception—may be considered. The duties of the physician are relatively clear. First and foremost in American civilization comes his duty to the patient (there are, of course, exceptions in the case of minors). Second, he owes many duties to the State. This is more particularly true in the fields of public health, etc., and need not concern us here. Far to the rear of these concepts follow what other considerations there are. If we admit the pre-eminence of the patient's health, we have simplified matters a great deal. We must simply ask ourselves and then carefully consider, “Will this patient's recovery and mental health be improved or retarded by knowing that he has cancer?” These patients readily fall into two groups, those who may be curable and those who are not. A specialist in cancer usually knows even after a cursory examination the site of origin of a neoplasm, and he knows or should know what percentage of these various types may be cured by radium, by x-ray, or by surgery. If he is at all honest he wishes to apply that therapy most likely to lead to a cure. All these instrumentalities are expensive and in many cases all three of them must be used. Almost every patient, without exception, is willing to sacrifice his material possessions if he can increase his chance of living as much as 1 per cent. Do we have the right to deny him not only the truth but also a full knowledge of these other facts which may aid him to determine his course? There is only one answer —No! But, you may say, the patient may take all this treatment without such suasion. Perhaps. How can one know in advance? If he “bucks” a little at some stage of the treatment and then you have to confess the truth, have you not lost his confidence? But, the relatives plead, he may commit suicide. He will not! There are few who cling to life as do the cancer patients, if they, in fact, believe there is hope for cure. The danger of their losing this precious possession only increases the desire to cling to it, in early stages when they still possess full mental powers. They will worry, yes, but it is very doubtful whether that worry is more intense when the truth is known to them than it is in the cases of those pitiful individuals who suspect, but who are repeatedly assured to the contrary. The scales and the mirror at least are honest. The Incurable Here the problem is more difficult.