Every physician must be free to tell the patient what he or she feels is necessary and appropriate. The problem is discussed with the patient’s family. The physician does not like to lie to the patient, because the patient will lose confidence in the physician if he or she were ever to discover the truth. Often the dying patient never asks a direct question about his or her condition. This does not mean that the patient is not aware of what is happening, but that he or she prefers to help the family, the physician, and himself or herself by maintaining the pretense that all will be well. The patient may not want to know how many months or years he or she has got to live. It is enough for the patient to know that he or she is not going to suffer.
Sometimes, however, the patient wants to know exactly what is the matter, what can be done about it, the likelihood of successful treatment, and eventually, the length of time the physician expects him or her to live. Most physicians give truthful answers to direct questions such as these. This honesty may in itself help the patient through moments of mental anguish. It also gives the patient a chance to put his or her affairs in order. The patient may not want the family to know that he or she understands the predicament. This makes it easier for them all to maintain a façade of cheerfulness. Recent surveys suggest that patients increasingly want to know about their disease and its exact prognosis, rather than being “protected” from bad news.
