WHAT if a patient suffers from an incurable disease and is about to die? Should the doctor tell him the truth? Al-Riyadh Arabic newspaper spoke with a number of physicians to know their stand on the issue. Dr. Muhammad Al-Juhani, an emergency medicine consultant at King Khalid University Hospital, said most doctors prefer to be frank with their patients who suffer from incurable diseases and explain to them their condition in detail when all treatment options are exhausted. "In my view, the one who is entitled to take a decision on the treatment approach in such cases is the patient himself," said Al-Juhani. He said if terminally ill patients are apprised of their condition, they can tell their doctors in advance, for example, to remove them from the life-support system the moment their hearts stop beating. Unfortunately, the families of such patients ask the doctors to hide the truth from the patients and many doctors succumb to such requests, he said. "Literally, it is the most difficult dilemma doctors face every now and then in this line of work," he added. If a patient finds out that he suffers from cancer, the first thing the doctor treating the patient should do is to refer him to a psychologist who will treat him for depression and anxiety, if he suffers from either, Al-Juhani said. "Most cancer patients who go through excruciating chemotherapy sessions need psychological attention because they suffer from depression and anxiety. If not treated, this could have a negative impact on the patient's health," he explained. Dr. Waleed Al-Malik, an assistant professor of health sciences at King Saud University, said incurable conditions that affect most Saudis include renal failure, liver diseases, heart and lung diseases and cancer. "Personally speaking, I have difficulty explaining to a patient that he suffers from a non-curable, life-threatening disease. Some patients refuse to accept the truth and travel overseas searching for better treatment," he said. Al-Malik does not usually reveal the truth bluntly to a patient who is terminally-ill and prefers to break down the news as nicely as possible without shocking him. He never fails to give hope to his patients and explain to them in full detail everything related to their disease. Patients who suffer from advanced stages of cancer and are experiencing excruciating pain usually are referred to the pain-relieving clinics to ease their pain. They are given sedatives and morphine to suppress the pain and help them get sleep at night. Painkillers are important and indispensable medications for such patients. Dr. Mahdi Al-Taher, psychiatric consultant, said cancer patients need to take medications for depression and engage in social events to keep their morale high. If a cancer patient surrenders to depression and anxiety, he will not be able to resist and fight cancer and will eventually collapse and die. Al-Taher is against telling a terminally ill patient that he is going to die even though, as a medical practitioner, believes that there is nothing ethically wrong in being frank with the patient. Dr. Hashim Balbaid, head of geriatrics department at King Abdulaziz Medical City, Riyadh, said patients in advanced stage of cancer usually need palliative care. Specialists talk to the patients and engage them in constructive conversations to boost their morale. "Only doctors who are qualified enough know how to break down the news to the cancer patient," he said.
