I just watched a clinician give a patient's family a brutal dose of reality, and half the unit thinks it went too far. The family was completely clinging to unrealistic expectations for a terminal patient, and instead of the usual soft, corporate-approved comfort care phrasing, this provider flat out said they are prolonging suffering, not life. It was incredibly uncomfortable to witness. Where do we draw the line?

Sometimes being direct is the most compassionate thing to do.

That’s the first in my 20 years of experience I have ever heard a provider tell family they are prolonging suffrage than life. But if they did say that to the family it would be the right thing.

As a hospice nurse I’ve unfortunately witnessed these conversations at care meetings/ evals sometimes families need a harsh dose of reality to break through the denial noise. I had a patient who was actively passing and her sister came in asking about dialysis and diuretics bcuz patient was retaining fluids. At this point pt wasn’t responding and oxygen sating low even on high flow oxygen I had to pull her to the side and let her know the reality that they had hours to days at best and to call family in and make arrangements. It was hard but she thanked me for the bluntness. Pt ended up passing 2 days later

That’s called advocating for the patient. However, it should be said with compassion and delivered emphatically .

From a bioethics perspective, the line is between being truthful and being cruel.

Families deserve honesty, especially when a patient is terminal and continued treatment may be extending suffering rather than improving life. That falls under nonmaleficence — do no harm — and beneficence, meaning we should act in the patient’s best interest.

But truth still has to be delivered with compassion. A family may be grieving, shocked, or holding onto hope because they are not ready to let go. The ethical approach is not to avoid the truth, but to explain it clearly, gently, and with dignity: “At this point, the treatments are no longer helping the body recover, and we are concerned they may be causing more suffering.”

Sometimes the most compassionate care is helping a family understand that comfort care is not giving up. It is shifting the goal from prolonging the dying process to protecting the patient’s peace, dignity, and comfort.

I have had to involve my facility's bioethics committee and go up the chain of command for someone who had 0 chance of recovery, was an advanced age and the family refused to let go. For weeks leading into months while this all played out. Sometimes families want to keep their loved ones around for themselves because they dont know how to let go. We won our case and the patient was placed on palliative care where they passed away within 24 hours. Sometimes providers have spoken to families at length using a variety of tactics before getting to the blunt truth.

I see nothing wrong with what the clinician said. Unless he or she were being condescending or yelling. Beating around the bush serves no one. Sounds like the family needed to get a dose of reality. If the patient is at the end of life with no quality and with no hope then prolonging their suffering can be cruel. . Sometimes the family is in denial and needs to be told the truth. Sugar coating it doesn’t help In many instances.

I wish more physicians were actually honest about end stage of life.

If I were the patient, I'd rather know the truth, painful though it may be.

Clear IS kind

As a prior hospice manager, it was always a difficult conversation to have with families. Yes, it needs to be had but with compassion. It’s not easy to accept the loss of your loved ones so be compassionate, be empathetic and they will be more receptive. They’ll even thank you too. We should all try to be kind with our actions and even more with our words. The word ‘care’ is attached to health for a reason.😊

Even though it is uncomfortable - it needs to be said.

It is unethical for a clinician to say they, "Are prolonging suffering not life." It is up to the patient and his family to decide whether the patient wants to continue to live and how much pain the patient wishes to tolerate. Religion might prevent someone from euthanasia. This is suicide. What do you mean "WE draw the line."? Doctors should not kill patients who want to continue living. By the way, what category of clinician? A phlebotomist is a clinician but not allowed to make a statement like you are prolonging suffering. A doctor should not say you are not prolonging life. That is a lie. That is malpractice because you ARE keeping the patient alive but in pain, so you are prolonging life. A patient might want to stay alive long enough to resolve personal issues like family arguments, finances, religious regrets, see the beach, go home, take care of a pet, etc.

There is nothing accomplished by being harsh. I once discussed the inevitability of a patient's demise with his wife. And after he passed, she actually found me and gave me a big hug. I think perhaps my body language had expressed how frustraring it was as a clinician to realize that you just couldn't save the patient. Then your job is to help make the loss as gentle as possible.

Having been in a situation like that but WITH a realistic understanding of what was happening but only bc our team never let us veer off course. There was slight and gentle course correction every time we started to move around and we were checked in with A LOT. In hindsight I’m recognizing so this very situation didn’t take place with our family and so that we didn’t get hit with a Mack truck impact that our loved one wasn’t going to make it despite the best medical interventions. This shouldn’t have happened like that for that poor family. The event is tragic and horrible in itself, for someone to lay blame on family for them wanting to live not fully understanding their actions is provider error. It’s unacceptable and inappropriate for any provider to then use such brutality to correct many clinicians mistakes by further traumatizing a patients family with harshness like that. That’s a vicious truth bomb whether there’s truth in it or not and really placing the ball in the family’s court when it should have been explained better to the patients family, Hospitals can make death awful and then worse or awful and predictable which helps with healing. That clinician wasn’t right to do what they did, esp because families like that need extra care and looking after FOR THE PATIENTS SAKE. Thats the hospitals responsibility to look after them and sometimes that means looking after a grieving family and helping them with these hard decisions from the start. There obviously needs to be a better policy in place.

"the unit" are not the Physician ultimately responsible for outcome. There are procedures in place to lodge and resolve patient care complaints. ​​

Having recently gone through something similar from a personal perspective, I would have loved to have been told yes or no regarding imminent death. The shock of it all took over and we couldn't determine if there was a chance left worth fighting for or not. I needed to just be told, no there isn't! It really would have helped in decision making

I think it may have been more prudent to ask “are you keeping this person around for YOUR benefit or theirs?” But what do I know.

Where do you draw the line? At reality. Truth is more important than sugar coating and giving a family unrealistic expectations to cling to. When did telling the truth become a problem? Only with this new generation of younger clinicians apparently. I am astonished anyone is questioning this. Shocked honestly. I would be incensed if a MD gave me false hope instead of laying it all out there for me. I want to know FACTS and just because facts are supposedly uncomfortable for some people to hear doesn't mean providing facts is inappropriate. Sounds like the people who found this uncomfortable to witness need to grow up.

Having been a family member who can identify with holding on to loved ones who are ready to transition & working in a hospital and nursing home, I get both perspectives.
In my opinion, family wise, trying to hold on to a loved one who may or may not have told us they're tired and let them go, we will NEVER fully experience what pain they're going through but can't transition in peace bc they're barley clinging to life for us What quality of life will they have if they could live? And at that point, they are near death & them holding on is bc we can't say goodbye.
I worked in this profession & lost a sister TWO WEEKS after being diagnosed with cancer and THERE IS ABSOLUTELY NO WAY a provider will give you false expectations after a grim prognosis unless an Act of God manifests, that conversation in itself is " Hope for the best but prepare for the worst". Don't try to pump and pry providers into saying what you want to hear, so you can blame them when the person transitions. I'm willing to bet this family knew and we're grasping at anything to change the outcome which was inevitable