Reason and Emotion in the Face of Cancer
I often advise families of end-stage cancer patients to give up illusions, care more for the patient, and stop useless treatments; but many cannot accept this emotionally.
A saying widely circulated in medicine is: sometimes doing nothing is better for the patient than doing something. For the overwhelming majority of end-stage patients, doing nothing is indeed better than doing something.
Forgoing treatment and providing good hospice care to an end-stage cancer patient avoids losing both the person and the money, spares the patient suffering, and gives the patient and family more time to share their final moments of affection. It is the most rational choice, though it hits many people emotionally.
The two elderly people in my family—my mother and my father-in-law—were both people for whom I actively decided to stop resuscitation. I myself pulled out the tubes on my father-in-law. When my own father and mother-in-law leave me one day, I will certainly not make useless struggles to prolong their suffering. And I will tell my son that, at my own deathbed, no futile efforts should be made; when my time comes, let me die with dignity.
Facing a life-threatening disease like cancer, there are many moments when we must choose between reason and emotion. Should we follow emotion or reason? Personally, I believe we should follow reason. On a foundation of reason, giving the patient the greatest possible emotional comfort is the best hospice care we can offer our loved ones.
Whenever I hear someone call me a 'miracle doctor' or sense a tendency to deify me, I immediately pour cold water on them. To be honest, what I fear most are patients and families who have lost their reason and hold unrealistic expectations of me. Especially some families of end-stage cancer patients: no matter how I stress that there is nothing more I can do for their loved one, they like to put a tall hat on me, hoping I will act out of compassion and save their family member.
Of course, providing psychological comfort to patients and families is also part of a doctor's social duty, but if that comfort is built on deliberately or inadvertently concealing the truth, we have to worry about intense emotional reactions from the family later.
If the family is clear-headed and well prepared psychologically for the prognosis, then I am very willing to offer comfort and guide and help them through the hardest days. Otherwise, I will make sure the family knows the misfortune that is coming and will not let them evade reality. This may seem cruel, but it is right.
When a family member has cancer, which treatment to choose and who ultimately decides is also a question where reason and emotion conflict.
I generally respect the patient's own wishes first, and only then consider the family's. In cancer treatment, the physician has only the duty to provide information for the patient to judge, not the power to make the decision for them. Because treatment decisions involve so many issues—the patient's and family's personal beliefs, educational background, life experience, and financial circumstances—this is a highly individualized matter.
Each party may have their own understanding and choice, and sometimes family members disagree sharply. When I face this, my practice is: when disagreements among family members are severe—especially when the patient himself does not want TCM—I withdraw. Even if the family especially wants me to treat their loved one with TCM, I firmly stay out.
When a patient passes away, what we face is dealing with the family; so the family's understanding of TCM and whether they are gentle and rational affect whether a doctor takes on a patient and to what extent.
For a long time, while being chosen by patients and families, I have also carefully chosen them; the patients and families I truly accept are not many. Good treatment outcomes require shared values and compatible temperaments, so when I sense that certain patients and families are unlikely to build a good collaboration with me, I withdraw on my own rather than waste the family's money.