Dying With Dignity

The setting: A medical conference exploring the use of Asian therapies for cancer.

The cast: Oncologists, cancer researchers, and healers of all descriptions as well as cancer patients and one bald and robed Buddhist chaplain.

The topic under discussion: The seemingly dispassionate manner of some doctors in their dealings with terminal patients.

Amidst murmurs of agreement (cold! uncaring!) from the audience, a medical oncologist rises to express the view from his side of the bedside [red.]. "Patients, even terminal patients, seem to have no tools to help them make sense of death," he muses. "How did I get here?" these patients wonder as they approach death's door. "What does it mean?"

The oncologist's question: Can I really be faulted for not having those answers? And isn't it just a little late to start grappling with spiritual issues of this magnitude with five minutes left on your clock?

Quickly, the sentiment in the room swings in favor of the harried doctor who, true to the tradition of triage, must turn his attention to the lives he can save, even while turning his back on the one he can't. There's no IV feed that delivers to dying patients the meaning of life, adds another doctor in the room. It's what they need and I just don't have it.

Although it's certainly true that some doctors are too busy or too detached to help patients grapple with end-of-life issues, that's not the real problem, concurs panelist Leslie Blackhall, M.D. Rather, our culture simply doesn't seem willing to accept death as an outcome, she says. The prevailing wisdom in modern-day America is that death is what happens to a small group of unfortunate people--no one we know, says Blackhall, who is the medical director of the Center for Geriatrics and Palliative Medicine at the University of Virginia School of Medicine. "Well, I'm sorry but that's a really distorted worldview."

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