Dilemmas: The truth hurts, but what if it is fatal?

IT'S awfully difficult not to let strong personal feelings cloud any response to such a difficult and serious question. I would so long, myself, to know if I were going to die that I find it hard even to imagine anyone not wanting to know. The knowledge would give me a chance to tidy up my affairs, say goodbye to people, put right old wrongs, and, perhaps, have the most glorious last few months of life by living it to the full. Indeed for me it would be a real treat to be told, and far better than just popping off surprisingly with a heart attack in my sleep, the way most people would prefer to die.

But there are those who shudder at the idea of being told the awful truth and one has to consider their views. And yet has Nina's mother's doctor really thought this through? He sounds a bit of a berk and anyway has no right to tell a patient's relative anything without her permission. Not only that, but there is absolutely no evidence that those who "battle" with cancer live any longer than those who weep and give in. Cancer is bigger than all of us, and no amount of visualisation, positive messages or Pollyanna-ish brainwashing makes any difference at all to the outcome. Battlers live just as long or as short as wailing hand-wringers. The doctor has also, by just telling Nina rather than her mother, put her in an impossible situation. He has let her into a ghastly secret, perhaps wanting, subconsciously, to unload the responsibility of telling the woman herself. Naturally, like an adulterous husband who wants to dump his guilt on a wife by confessing all, Nina also wants to rid herself of this information by telling her mother. The secret is too great for her to bear on her own.

I would have thought that the doctor could easily have told Nina's mother in a roundabout way what might happen - "To be honest your prognosis is not very good, but even though doctors have very good ideas, we can never be absolutely certain what the final outcome will be" for instance. This would beg the question from her: "Well, how long do you think I have?" If she remained silent, he would know that she didn't want to know. Indeed, it seems odd, if she has cancer, that she hasn't already asked how long she's got. Isn't it the first thing that flashes into one's mind?

Nina's been thrown a ball of fire by her mother's doctor and it's burning her hands. I think she should chuck it back into his court with the threat that if he doesn't at least broach the subject with her mother, even in a roundabout way, within a few months she will have to tell her mother herself. But she should add that she feels the news would come better from him, as indeed it would, including a lot of flannel about the doctor/patient relationship and how she's sure he's "so good at telling news like this."

But if he refuses to tell, I think, on balance, that she should, particularly if she and her mother have a relationship that she wants to cherish.

WHAT READERS SAY

Doctors should always take their cue regarding how much to tell the patient from the patient. The doctor has a responsibility to be honest with his patient and to give her as much information as possible, while at the same time making sure that she is not given more than she can cope with at any one time.

Doctors have a compelling duty of confidentiality to their patients and this doctor has clearly flouted this duty in telling Nina her mother's prognosis in advance of telling the patient. - Dr Michael Wilks Chairman of the Medical Ethics Committee, British Medical Association

My stepfather died two weeks ago, from bladder cancer. The family doctor told my mother that he had only a few weeks to live. It was my mother's wish not to tell my stepfather because she was able to predict his reaction. Unfortunately, the doctor decided to tell him that his condition was terminal. He became extremely depressed and lost the will to live.He died a week later. The day after the doctor told my stepfather, my mother asked him if he wished he didn't know and he said yes.

You say your mother is not a very strong character and has a tendency to depression; then you must not tell her. At the moment, your mother must be feeling relatively fit and healthy, it's important that she feels like this for as long as possible. - Sheran Saint

I strongly feel that Nina's mother should know the truth, which will deeply affect the way she lives her remaining time. I am amazed actually that a doctor would conceal the truth from a woman of only fifty three.

- Julia Walsh

My father, a fit and intelligent man of 63, was diagnosed with cancer of the lung lining. We were told he could have only three months to live. Our GP very strongly advised that this should not be discussed with him. My mother was adamant that he should not be told. For the next seven months, as that was how long he lived, I saw him become more and more isolated as plans were secretly being made for his death. I desperately wanted to talk to him about any last wishes he may have had.I strongly feel that he was denied the right to be involved and take some control over what was happening. I would say talk again with your doctor and see if this information could be made open, and grieved for, in a shared way. Your feeling that you are deceiving her is a reality and will only intensify.

- Anon, Eltham SE9

NEXT WEEK'S DILEMMA

Dear Virginia,

After a great deal of distress and anxiety I have, at 45, managed to master a word processor and I'm now quite adept at it. But I work from home writing reports for a company and I've just had a letter saying that in future they will only accept stuff on e-mail or modem. I can't sleep for anxiety and sometimes cry at the prospect of trying to get the hang of it.

I don't know where to begin. I get different advice from everyone, using words I don't understand. My son's thrilled at the idea and says I'll be able to get on the net and communicate with people all round the world. But I don't want to. I know other people have phobias about new technology. Can any of your readers give me advice on how to overcome the terror I feel?

- Julie