Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations. Principle 4A, APTA Code of Ethics
CASE 7.1 An Unwanted Discovery
Jim Yonemoto is a physical therapist employed at a hospital. He has been assigned a patient recovering from surgery for a total hip arthroplasty. The patient will need 3 weeks of therapy that will include active range-of-motion exercises, strengthening, and gait training. Everything looks typical until the therapist learns that the patient has a life-threatening cancer. The nursing staff, in administering routine care, had noticed three darkly pigmented moles on the patient’s back. A dermatologist was called in to do a biopsy, which led to a diagnosis of multiple-site, stage four, melanoma. Further tests revealed that the cancer had invaded the lymph nodes. The information about the cancer has no direct implications for the services provided by the therapist, but does it have any wider relevance to how the therapist will or should interact with the patient?
Some physical therapists rarely work with patients who have life-threatening illnesses, and other therapists, such as those in hospice care or in skilled nursing facilities, work with many. Either way, the topic of death is not incidental to therapists. Life-threatening diseases multiply anxieties in patients and their families, and sometimes they affect the therapeutic regimen. Moreover, therapists need to understand their own responses to death in order to communicate effectively with patients and to provide emotional support. Further, what should physical therapists do on learning that a patient is planning assisted suicide or when patients with whom they have a long-term relationship “sound out” their views on assisted suicide?
We begin by setting a wide context about the meanings of death. Invariably, those meanings are linked to meaningful life—not in the sense in which all human beings have moral significance, but in the sense in which individuals experience their lives as worthwhile, rather than as worthless, pointless, or futile.1 Why do people fear death? Which fears are reasonable? How should physical therapists respond to those fears in themselves and others?
Next we turn to practical questions about understanding and communicating with patients who have life-threatening diseases. We also discuss the dynamics of interacting with family members, especially when the patient is a child. We conclude by discussing suicide and assisted suicide, issues that are becoming increasingly relevant to all health professionals.
FEAR AND ACCEPTANCE OF DEATH
Most people calmly acknowledge the need for death. An immortal species would quickly overpopulate the biosphere, destroying ecosystems that make possible ongoing cycles of new life. But with regard to oneself and the people whom one loves, accepting death is more difficult. Most of the time fear of death remains muted, as in the case of Ivan Ilych, the protagonist in Leo Tolstoy’s Death of Ivan Ilych. Ilych lived ...