Dealing with Death/dying in Medicine

Abstract

The medical field has consistently made remarkable progress in developing treatments for previously incurable illnesses, improving clinical outcomes, and alleviating pain and suffering. Yet, the time-honored problem of human death remains an inevitability of life that modern medicine can never defeat. Indeed, Dr. Benjamin Franklin famously quipped in the 18th century that “in this world nothing can be said to be certain, except death and taxes”. Ironically, as medical physicians who are thoroughly trained to diagnose and treat a wide spectrum of illnesses, we often find ourselves wholly unprepared and uncomfortable to come face to face with death and dying in clinical settings – because it serves as an unwelcome reminder of the limitations of modern medicine and the inevitability of our mortality, conjuring up unconscious feelings of fear and anxiety. However, unrecognized and unresolved negative emotions and attitudes of physicians toward death/dying can have serious implications for both patient care and their personal well-being. For instance, physician discomfort and fear towards death/dying may manifest as maladaptive clinical behaviors such as avoidance, over-attachment, condescending/dismissive behaviours, or becoming robotic and emotionless in interactions with dying patients and their families. Moreover, there may also be suboptimal clinical care delivered, such as an unwillingness to break bad news to patients in a timely manner, or developing incoherent treatment strategies and care goals. Finally, physicians who labor under heavy emotional burden in providing care for dying patients eventually suffer from burnout and lose their sense of work fulfillment and purpose. In this article, we suggest multi-pronged, practical strategies to help physicians cope with the psychoemotional aspects of caring for dying patients in a healthy and meaningful manner. This includes normalizing conversations about death in the medical field, cultivating physician insight and emotional self-regulation towards death/dying, and developing a robust psychological support system for physicians providing care to terminally ill patients.

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