Culture of silence around talking about death and terminal illness

Culture of silence around talking about death and terminal illness

In the past, it may have been acceptable for doctors not to tell a patient they had cancer. There was a culture of silence around talking about death and terminal illness (Heyse-Moore 2009). In On Death and Dying (Kubler-Ross 1973) Kubler-Ross said it was often the wife or husband who was told the diagnosis and then had the burden of whether to tell the painful truth.

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However, the development of the Hospice movement and Palliative Care in the past 30 years has made it the duty of health care professionals to inform patients of their diagnosis. Now, there are General Medical Council guidelines (2006) that make it an ethical duty for the doctor to inform the patient of the diagnosis (Heyse-Moore 2009).

Parkes (Parkes & Markus 1998) discusses the importance of breaking bad news effectively and sensitively. Parkes sees this as an element in preparing for loss. He is specifically discussing how to care for the terminal patient, so this may be a limitation (Parkes & Markus 1998).He describes how the doctor should arrange and meet with patient. It is notable he does not provide exceptions and does not discuss involving family or speaking to a spouse first.

Parkes provides practical guidance possibly gained from clinical experience. He advises finding a “homely area” where everyone can be comfortable. This can be a place where everyone can sit and not be disturbed. The decor should be the opposite of clinical if possible. He discusses giving as much information as the patient can cope with, and suggests “bite sized chunks” of information (Parkes & Markus 1998, p. 8).

He suggests inviting questions from the patient and using this to guide how to prevent information. The difficulty in talking about dying is where the patient becomes distressed and anxious, they may not take in what has been said, and may not fully understand the diagnosis or terminal nature (Parkes & Markus 1998).

If the dying person has a “thinking” coping style then the doctor can begin to help him/her focus on the feelings involved and expressing them; and vice versa for the person with a “feelings” coping style where the focus might be on the problem solving (Parkes 1996b).

In Bereavement: Studies of grief in adult life (Parkes 1996a) discusses the tendency for the family to conceal the truth from the dying person. He is clear that the patient should be told of the terminal illness. According to Hinton (1967) (see Parkes 1996a),