I would not serve that patient well by my meeting that expressed need for death, because that expressed need is the result of my failing to meet the real needs of the patient. We have great knowledge and must use it wisely. We are called by the dying to be their guides through this final passage. We are simply to be guides who provide a sage experience as they explore their final days. I teach all new hospice staff members that in working with the dying, what is not said is often far more important that what is said.
Nothing can shatter a relationship more quickly and more completely than dishonesty.
To be sure, we do not hit people over the head with the truth they are not prepared to hear. That would be cruel. We must rigorously avoid a self-serving deflection of crucial issues and truths in order to spare patients and ourselves the pain of honesty. There is no doubt that the first casualty to managed care has been time. There is no doubt that our professional lives have become so pressured, so hectic as to reduce us, at times, to machine-like activity, constantly whirring and clicking toward the next task.