As I explained the dire nature of her condition, it became clear that he was not willing to stop treatment because he was uncomfortable telling her that she was terminal. In many instances, the patient and the family have not been fully apprised of the terminal nature of the illness. Physicians are generally reluctant to tell a patient that all possibilities have been exhausted. This seems to signify to some practitioners that they have failed to provide a safe haven to patients who have entrusted their lives to them. The physician must in that instant, either consciously or subconsciously, face his or her own aversions to death and their patients personal fears of the unknown.
Communication is the cornerstone of palliative care medicine.
It is important to contact the patient s primary physician to determine the extent to which the practitioner has acknowledged and communicated to the patient that he or she is terminally ill. Further, it is important to understand as many of the sometimes conflicting recommendations that the family has received. It is not unusual to have the primary care physician ask the palliative care provider to actually discuss the terminal nature of the illness with the patient and the family and to problem-solve care options. The logistics of doing such discussions are very individualized. One must take into account the role of the patient s family and cultural values, the issues of denial, any contribution that suffering may be playing in the dying process, and how or if the patient and family have embraced the grieving process.