Don't Tell Me Anything Negative
By Paul R. Helft, MD | May 15, 2013
While on call over the weekend, I looked after one of my partner’s patients who is approaching death from advanced, refractory ovarian cancer. She ended up in the ICU with what was believed to be a bowel perforation and sepsis, and I and the intensivists on the case felt that she could die within a few days. She was completely lucid despite her condition, and refused to discuss any treatment limitations, despite the fact that all of the physicians involved in her care agreed that her prognosis was terminal. When I tried to discuss these issues with her, she asked me not to talk about anything negative with her, because she needed to find something hopeful to hang on to. Decisions need to be made—should I just remain silent about them at her request? We can’t really make any decisions without discussing negative things.

Dr. Helft Responds:
This situation represents a difficult but all-too-common situation. more .....
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