Should a dying person be told that they are dying? We present a list of views and considerations.
The Conversation Part 1:
Dr Louis Heyse-Moore Dr Robert Buckman Dr David Servan-Schreiber Osho
Should we tell a dying family member, friend or patient that they are dying?
Let’s consider some views….
Doing the ethical thing
‘The patient has the right to know and not to tell him is to infantilise him,’ says former palliative-care consultant, Dr. Heyse-Moore. ‘How else can he decide what action to take?’
He explains that just fifty years back, in the UK – in the name of avoiding causing the dying person pain – it was considered ‘good practice’ for doctors to use euphemisms or to lie. Now, the guidelines to doctors ‘insist that it is an ethical duty to tell patients what is wrong with them. Furthermore, such information can only be given to the family with the patient’s consent.’ 
Doctor and neuroscientist, David Servan-Schreiber, who himself was to die of brain cancer, writes…
‘My experience has led me to believe that in order to confront illness as best you can, you need to think about death. This question haunts anyone who suffers from a terminal disease like cancer, even if they don’t talk about it. As soon as someone says, “I have cancer, I’m undergoing such-and-such a treatment,” death is in the picture.
‘I’m convinced it’s better to put the subject on the table and consider it from all angles, practical and symbolic, so that when the time comes, it can happen in the best possible way. At that point, it is the most fundamental subject in the patient’s life, and he or she wants to get it right…. The family might…prefer to avoid the subject as long as the person’s state of health is not too bad. But then it’s often too late as the patient is no longer in a state to be able to discuss or even to think about it…
Having said that, elsewhere Dr Servan-Schreiber suggests there’s no good time to address the subject of imminent death and warns against overwhelming the patient or giving then the impression that ‘it’s over.’ ‘Better,’ he advises, ‘to remain vague and nuanced, even if that isn’t always easy. Yes, death may come, but it’s not a done deal and cure is never out of the question.’ 
Yet if there’s ‘no good time to talk about death’ does it go unacknowledged entirely? And some individuals are bound to prefer the cards being laid on the table rather than a ‘vague and nuanced’ approach. On the other hand, one might want to bear in mind the nocebo effect. For example, a patient being told by their trusted doctor that they will die can be enough to make a few people do exactly that.
It is said that a dying person knows that they are dying; and it can be that it is they who decide to say nothing in order to protect their family and friends. So it can happen that just when everyone needs each other as never before, both patient and friends/family members put on a brave face and cover their unexpressed sadness with platitudes.
Maneesha recalls being asked to see a client who had a Stage 4 brain tumour. She had a loving partner and also a large network of friends. They were active in seeking out and suggesting to her a whole range of complementary treatments – from psychic healing to whale bone cartilage.
Opening the door to Maneesha for their session, she greeted her with a big smile and the words, ‘Thank goodness: someone I can talk about death with!’
It is better to tell the truth, the mystic, Osho, suggests. Death is such a big thing that it should not be kept secret. And, after all, it is the individual’s death; they have to know about it.
On one particular occasion when a woman tells Osho that her family don’t want to talk about the fact that her brother is dying, he responds…
‘…That is absolutely foolish because then he remains continually worried about his life, because he thinks he is going to live and everybody is pretending that he is going to live. So just find a silent moment when nobody is there, and release the news to him.
‘It may be shocking but it is good because once a person knows he is going to die, immediately his interest in this world is lost – immediately… Once you know you are going to die…immediately this world – the money, the bank, the business, this and that – is useless. Now everything is no more than a dream and you are already awakening…. Once you [tell him he is going to die]… then meditation is possible. He is no longer here: he has started to look to the future, because when one is going on a journey one starts the preparation.
‘At that moment, if you tell him about meditation he will be willing to do it – and that can be one of the greatest gifts.’ 
What if the person/patient doesn’t want to know?
As Dr Heyse-Moore sees it there are some instances when one should not break ‘bad news’ to ill people – i.e. if they make it clear they do not want to be told; they are demented to such an extent that they forget what they have been told; they are so confused that they cannot take the news is; they are paranoid and might incorporate what you tell them into their delusions. 
If the person seems not to want to know, you can assess the situation by asking yourself: Is there any particular need for them to know? Are they becoming distressed by not knowing?
‘Information should always be offered but sometimes it is rejected. If there is no medical or social need to deal with that information,’ says Dr Buckman, ‘then I think you, as the friend of the patient, can be comfortable in leaving the denial alone and accepting it as the way this particular person is dealing with the threat.
‘If on the other hand there are reasons that the patient has to know what’s going on, or if the denial is causing great distress to the patient, then you should look for some expert help.’
Studies of patients with cancer show that most patients do want to know exactly what’s going on, and need to know in order to make intelligent plans for what’s going on. Furthermore, studies comparing the mental state of patients who do not know what’s happening, compared with those who do, show that patients who are kept in the dark have far greater problems with depression, anxiety and a sense of isolation.
Dr. Buckman notes that ‘most of these feelings faded away when the patient was given the information he wanted. …’ 
1, 4) Speaking of Dying: A practical guide to using counselling skills in palliative care Louise Heyse-Moore (Pub: Jessica Kingsley)
2) Not the Last Goodbye: on life, death, healing and cancer David Servan –Schreiber (Pub: Viking)
3) The Art of Living and Dying Osho (Watkins)
5) I Don’t Know What to Say Dr Robert Buckman (Papermac)