Opinion | Talking With Patients About Death


To the Editor:

Re “As a Doctor, I Know Being Ready to Die Is an Illusion,” by Dr. Sunita Puri (Opinion guest essay, April 2):

Many doctors, including me, have faced Dr. Puri’s dilemma about how to talk to dying patients. My early years as a specialist were besmirched by my failure to inform patients, in a timely fashion, that they were dying. Used to playing the role of a problem solver, I had no skills in consoling an explosion of grief.

The rapid expansion of medical ethics in the 1980s put patient autonomy and rights on a pedestal, demolishing paternalism. Indeed, several courts have found doctors at fault for nondisclosure of proximate death. Research has shown that the vast majority of people surveyed would want their doctor to inform them, without prompting, if they were dying.

Over the years I was able to break down my self-created barriers, and in doing so realized how many people were grateful for the truth, which allowed them to reschedule family events, go on trips and “get their affairs in order.”

Adrian Fine
Victoria, British Columbia
The writer is a retired professor of medicine at the University of Manitoba.

To the Editor:

Reading this essay brought back vivid memories of the death of my friend Marsha. On Easter Sunday 2021, when Covid had locked down the country, she finally agreed to let me come in to help her. She was dying of cancer — and she knew it.

She had always been an independent, organized and caring person. Now those qualities propelled her to act. With me as her hands she wrote her last checks, filed her papers and distributed her jewelry to loved ones.

On our last night she cried out in her sleep. I sat beside her and we spoke of an afterlife. She, raised in the Jewish faith, wasn’t sure anything existed after death. I, a lapsed Catholic, shared my belief of heaven as a place of peace and joy. There would be no pain. I treasure her last words: “I hope you’re right!”

Dorothy Landau
Smithtown, N.Y.

To the Editor:

Sunita Puri’s article on the illusion of being ready to die is one part of a larger issue for our aging society. How the patient feels about death and dying should be included in doctor-patient discussions.

Patients should be encouraged to talk to their families and friends about their feelings before they are dying. These discussions can be difficult. But as someone who has been with a number of people who chose to end their life legally on their own terms, I can attest to the fact that people who do have these discussions are more content when they die. And their families are better prepared and thankful they took the time for the discussions.

Brian Ruder
Portland, Ore.
The writer is president of Final Exit Network.

To the Editor:

Bravo to this doctor for sensitively writing on the topic of death. In our curative medical culture of “doing all” to prolong life, I welcome articles that examine the palliative and hospice aspects of care.

I have worked in an acute care hospice home as a volunteer. I have been given the gift of being with others as loved ones have passed, and as my own loved ones have passed. I have heard the words “I am ready to die” from family and friends.

Perhaps it is for lack of a better word that we use “ready” in an attempt to explain ourselves or what we perceive in others. I had a beloved girlfriend explain, as she shared her decision to stop her chemotherapy treatments: “I am not ready. I am resigned. I am tired. I am aware. I am sad. There is more that I wanted to do.”

Stephanie Carnow
Carlsbad, Calif.

To the Editor:

A surgeon spent hours replacing two of my heart valves and bypassing a coronary artery three years ago. The following day, I was in intensive care and talking with my wife when I heard distant alarms and began to fall asleep. Soon, I woke up to a white-coated team around my bed that was calling my name as one removed crash-cart paddles from my sore chest.

That same day, the cart was called to revive me three more times. After the fourth visit, I said to my wife, “Don’t bring me back again.” I was exhausted. The crash-cart team was exhausted. I had done my best to hang in there but now was ready to depart. I felt at peace.

Dr. Sunita Puri recalls that her patient told her: “Not sure if I’ll ever really be ready. It’s not like packing a bag and standing outside waiting for a taxi.”

At 79, I admit that my illusion was wrong. I am glad I did not catch the cab that I was expecting when I was ready to give up.

Larry Lamb
Chapel Hill, N.C.

To the Editor:

Re “Colleges Should Be More Than Just Vocational Schools,” by Bret C. Devereaux (Opinion guest essay, April 5):

The decline of the focus on liberal arts in the nation’s universities is deplorable. A nation needs citizens who are familiar with its traditions and values.

One cannot be a responsible citizen in today’s world without knowing about our history, warts and all, and one cannot be an interesting human being without knowing something about art, music and philosophy.

Don’t play down the value of a liberal arts education in the business world. I am a retired corporate tax lawyer. When I was hiring young lawyers for our firm’s tax department, I looked for history and English majors.

I wanted people who could think conceptually and critically. I wanted people who could write persuasively and use the English language to explain and persuade. One does not learn how to do this by studying double-entry bookkeeping. One does so by reading Jane Austen and Anthony Trollope.

Peter L. Faber
New York

To the Editor:

Bret C. Devereaux presents a refreshing take on the increasing specialization of colleges. As a STEM major at a liberal arts university, I have witnessed the effects that the liberal arts have on students’ self-discovery, including my own.

I came to college excited to pursue my passion for psychology in preparation for my career. However, because I attend a liberal arts college, I discovered my love of art and plan to apply this by conducting art therapy as a clinical psychologist.

While majoring in finance will prepare you for the tasks of a career in that field, these courses may not help you learn the problem-solving skills, creativity or civic responsibility that are just as necessary to succeed in the work force.

While the most significant argument against liberal arts is their impracticality, these classes have fostered my critical thinking and interpersonal skills, improving my performance in other academic courses and making me a more competitive candidate for jobs.

Elizabeth Ruel
Fairfield, Conn.

To the Editor:

Re “90 Has Become the New 60,” by Gail Collins (column, April 13):

Ms. Collins is absolutely right! My personal life has essentially been unchanged since I was 60. Retirement simply means greater flexibility of schedule — and an absence of salary. I still travel and write for professional journals.

I observed my 90th birthday in 2021 by skydiving. Want a photo?

Paul R. Lehman
Austin, Texas
The writer is emeritus professor of music at the University of Michigan.

To the Editor:

I’m 90. It’s not the new 60. I eat well and exercise. I like to think I’m the new 90.

William Buffett
Arlington, Mass.



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