Nobody is terminally ill.....

Before holding the moral compass that needs prominent use in today's medical society, lets first dive into the subject matter in hand. What is a terminal illness? 

A terminal illness is one from which there is no expectation of recovery
In the Netherlands where euthanasia is legal, terminal has a concrete definition, it literally means "concrete expectancy of death".

In Oregon where assisted suicide is legal in 'terminal cases', terminal is described as a condition which will "within reasonable judgement, produce death within six months."

A terminal (life-threatening) disease can be described as having five phases: first there is the phase before diagnosis, then there is the acute phase, the chronic phase, the recovery phase, and finally the terminal phase.

1. Before Diagnosis - a period of time when a person begins to recognize symptoms and realizes that he or she may have contracted an illness. There is no one particular moment of recognition but a growing awareness something is wrong.
2. The acute phase - when diagnosis occurs and the person is then forced to understand their situation. Medical decisions will need to be made concerning their care.
3. The chronic phase - between the diagnosis and the result from the treatments during which the patient juggles everyday life with medical treatment. This can last for months.
4. The recovery phase - occurs when final acceptance of their condition is realized. This does not always mean remission, but the ability to cope with the mental, social, physical, religious and financial effects of their illness.
5. The terminal (final) phase - this occurs when death appears as very likely. The focus now moves from attempting to cure the illness to providing palliative care.

With the above preface in place, lets try to interpret my topic. Nobody is terminally ill. YES, you heard it right. The term we so frequently hear in our medical journey has no point in existence for me. Terminal illness is a term that has been defined by many , interpreted by others but misunderstood by the entire human race. I am not here to question the science or the physiology behind these diseases. Being a medical student, i understand and appreciate the science in medicine. My problem is with the humanities, the moral aspect, the ethics woven to this topic. 

I am a doctor. I go to a patient and his family and announce:" i am sorry! You are terminally ill." Imagine the gravity in the words. No four words can make you and your family more sad than hearing these words.The diagnosis of a terminal illness is a life-changing event, not only for the patient but for the patient's family as well, and can trigger feelings of depression. As a medico, it is our job to share the true result with our patients and ready them to take further steps. But i don't agree with the way we do it, the terms we use, the values we portray to our patients.

No doctor should ever tell a patient that he/she is terminally ill. What he must say is: " My knowledge and skill to help you has terminated."

It just a play of words but it changes the entire paradigm of current medical practice of handling these cases. By saying someone that you are terminally ill, you are saying death is inevitable ! By saying your knowledge and skill to help them has terminated, you are saying i cant help you anymore but i don't say god cannot help you.

I don't mean to say that god will magically help the patients with whom we break the news differently and counsel them differently. But correct counselling in these cases can give people hope. NEVER DEPRIVE ANYONE OF HOPE BECAUSE IT MAY BE ALL THEY HAVE. Just by changing the way we counsel the patients and the terminologies we use, we can give patients hope and there are many inspiring, even miraculous recoveries which defy medical diagnosis and knowledge.  

Tests done on a 74 year old woman confirmed the worst suspicions: it was carcinoma, a form of skin cancer. After 20 weeks, patient was cancer-free. “There had been no doubt about her diagnosis,” the doctor says. “But now there was nothing in the biopsies, or the scans.”Somehow, she had healed herself of arguably our most feared disease. “Everyone was thrilled, and a bit puzzled,” she says, with some understatement. “It shows that it is possible for the body to clear cancer – even if it is incredibly rare.”

Another woman was diagnosed with breast cancer at age 42. When the doctor didn't give her any hope, she turned to changing her lifestyle. She radically changed her diet and exercise routines. And six months later the tumor was gone. Another woman turned to faith. She says she beat cancer not with chemotherapy but with the law of attraction, the strong willpower to not give up and mentally fighting with the disease.

I know i am pointing out at the most minority of cases maybe 1 in a million to make my point. But what we medicos must accept is that healing is not a purely 1+1=2 phenomenon. Human body is a complex blend of physical, mental, spiritual, social and psychological entities. Healing is not only done by chemotherapy, healing can be done by faith! I am a future doctor but never in my most logical of moments will i say that i treated a disease. I will say i gave you the tools, aided you with my skill but the actual healing was done by a power higher than all mere mortals.

The physiology of terminal illness is a developing subject. we don't know everything about for eg: cancer. So what / who gives us rights as responsible medical professionals to predict someone's death or take away the hope of life. The therapy of these diseases is mostly based on patient responses than concrete scientific and medical evidences. We don't know why some medicines work or how they work. We just know that they work. Our knowledge is very limited. As a result, we cannot ridicule any hypothetical theories on why the handful of women overcame these diseases the way they did. Maybe the body has a special mechanism to fight cancer that through their unconventional methods like adopting radical diet clicked within these women. Maybe these women were genetically more suited to fight terminal illness. We just don't know. 

In this bliss of not knowing. i feel safe that my arguments cannot be ridiculed because noone knows the truth. Maybe i am completely wrong about the physiology but i am not wrong about how we doctors must handle sensitive cases. We must be symbols of hope even when we convey the most painful of diagnosis. Since we don't know the treatment (tats why they are called terminal in the first place), the least we can do is offer hope and allow if not encourage patients to adopt unconventional treatment methods that may not confer with modern science. At the end, healing starts in the human brain. So we must be open to newer unconventional methods of treatment and study these miraculous cases in more seriousness than naming them just a happy miracle in a news headlines. These patients healed. They are our data. We need to analyse them with an open mind but also within the realms of logic and science. 

The main idea that i want to impart is much more important than the science involved. Doctors must be more compassionate, more involved, more supportive and provide all encouragement of life instead of declaring someone terminally ill. Noone is terminally ill. We just don't have the keys to unlock the world that has stayed hidden from us. A little change and a diplomatic use of words can bring about a revolution in lives of patients who have lost hope for life.