Should Terminal-Stage Cancer Patients Still Receive Treatment?

Terminal-stage cancer patients often hope that a TCM physician will perform a survival miracle for them, because Western medicine has already given up on them, and the great majority of TCM physicians also refuse to take them. But the patients' families cannot let go; they cling on and beg the doctors to treat their loved ones.

Treating terminal-stage patients usually ends with the family losing both their money and their loved one, and after the patient dies the doctor is easily blamed by the family, so doctors are unwilling to take such cases. For a doctor, treating one terminal patient costs more energy than treating dozens of mild cases, yet the final result is rarely satisfying; the doctor feels frustrated, the doctor's reputation is easily damaged, and with unreasonable family members it can even be dangerous. This is why most doctors decline terminal patients.

If the patient's condition is already critical—the tumor burden is heavy, complications are severe, and yet the patient and family still hold high expectations, hoping the doctor can work a cure or achieve tumor-bearing survival—then almost no doctor dares to take the case. No doctor can meet such high expectations.

For terminal-stage cancer patients, a reasonable expectation is to relieve the patient's suffering, not to fixate on survival time. If the family is clear-headed and rational, and the patient genuinely has room for improvement, doctors—after careful assessment—should try to relieve the patient's suffering. But they must also communicate fully with the family, disclosing the medical risks and the uncertainty of outcomes. With the family's understanding, treatment should be reasonable and limited; the patient should not be over-treated.

For severely terminal patients, well-resourced institutions or doctors should find ways to soothe the family's emotions, provide necessary death education for both patient and family, and suggest that in the final stage they choose humane care—abandoning all treatment or using only placebos.

A few days ago, when talking with the son of a cervical cancer patient, I learned that his mother had been in the hospital on ventilator and artificial nutrition for a month, kept alive. Every day she lay amid the stench of her own stool, her consciousness long gone; had these medical supports been withdrawn, she would have passed away long ago. Yet she lingered on, painfully sustained by modern medicine.

In speaking with the son, I described how I handled the passing of my own mother and father-in-law: giving up all meaningless life-sustaining treatment and letting them die more humanely in a natural state; neither suffered greatly at the end. After hearing this, the family member deeply agreed and decided to choose this more humane way to face his loved one's passing.

At the terminal stage, the patient's condition may no longer change by the month or week, but by the day or even the hour. One hour the patient can urinate normally; the next hour no longer. Treatments that worked earlier quickly fail at the terminal stage, and each new regimen works for only a very short time. Brief improvements repeatedly kindle great hope in the patient and family. But the doctor should communicate as much as possible with the family, explaining that these are only temporary phenomena, so that they stay clear-headed and prepare psychologically for the patient's passing.

The cost of sustaining life through the final stretch is the highest. A Singapore survey showed that 70% of a person's lifetime medical spending occurs in the last few months of life. Enormous sums buy back only an extremely short survival—something that must displease the family.

Moreover, medicine is a bottomless pit; as modern science advances, ever more expensive life-sustaining measures appear. Stanley Ho, the Macau casino tycoon, spent 1.4 billion yuan to prolong his life. For the great majority of wage earners, that is a sky-high price. For some poor families, even a few hundred yuan is a heavy burden. So patients and families should treat terminal cancer treatment rationally, avoiding prolonging this final, quality-free stretch of life at enormous cost.

I often recommend the book Being Mortal by the American surgeon Atul Gawande to terminal patients and their families, hoping that by reading Dr. Gawande's work they will deeply understand the meaning of humane care in a patient's final stage and view life and death rationally.

Dr. Gawande's own father was a cancer patient; the Gawande family are all doctors, and his parents plus Dr. Gawande himself together have 120 years of medical practice. At the end of their lives they chose the least treatment and the best care, striving to let the patient live with dignity.

His father kept working as long as he could—because he did not want these last days to be meaningless. Work made him forget the suffering the disease brought, even though in the end he could work only in a limited way.

From birth to death is a natural law no one can escape. When death is inevitable, making the dying process less painful is more humane and more meaningful than trying to block death. I hope terminal patients and their families can be more rational about this. Rather than hoping for a miracle, be kind to your body and spend these final days as comfortably as possible.