Editorial Humanismand Cancer

The historicConferenceon Human Valuesand Cancer,sponsoredby theAmerican Cancer Society in June of this year, placed in proper prospective theimportance of compassion, the need for sympathy and the true worth of consideration for other human beings. It also stressed that we, raised to believe in tomorrow and seldom thinking of our own finiteness, must learn to live with theuncertainty, the ambiguity. of our own lives since this will determine, to someextent, how effectively we can meet the needs of the cancer patient.

Many of the questions which daily confront us were wisely answered at thisconference. How can the cancer patient best be prepared for treatment? Welearned that we must devote our energies to preserving the patient's psychic. aswell as physiologic, integrity—that we must offer him an “¿�egoprosthesis.― Thecancer patient needs encouragement from us, from others who have undergonesimilar experiences, from family and friends. He needs honesty, understandingand support.

What should we tell the cancer patient? Would we as patients want to knowour diagnosis? Years ago. many of us were taught that patients should never betold a diagnosis of cancer—unless one could answer the question: “¿�Doctor,howlong do I have to live?― But today. the patient, more aware of health mattersthan ever before. may very well already know that his diagnosis is cancer. And.indeed, one of the greatest mistakes we can make is to predict precisely the patient's life span. Many patients who were given a short time to live have outlivedtheir doctors by years. And if the cold and bitter truth must be told to a patient. itmust be told with hope and confidence. The right words, the proper attitude andtiming are essential but even more important is the maxim that the patient he toldonly what he is capable of comprehending. And his fear of death? We learnedthat even stronger than the patient's fear of death is his fear of desertion, his fearof silence and charades. Communication, objectivity, ritual and doctrine are ourshields against these fears. Death need not represent defeat; mortality can he accepted with equanimity rather than rage. As Shaw said, “¿�Theonly difference between one man and another is the stage of disease at which he lives.―

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How canthepatientwithadvancedcancer—which,we arereminded,isnotasynonym for “¿�terminalcancer' ‘¿�—bemost successfully managed? The speakersat the conference used these key words: continuity, contact, communion, comfort. sensibility. sensitivity. realism, confidence and. above all—a sense of tomorrow. a sense of hope. Since each patient may improve, we must be persistentand deny medical passivity. But. we must also protect the patient from the medical or nursing urge to do something. anything. at the very end. Our duty is toprolong life, not the act of dying. And. at the end of the journey, we must respect the patient's wish that he leave behind the inheritance of an unscarredmemory. a quiet reverence, a certain admiration.

After repeated emotional crises, one wonders how physicians themselves manage to survive—plagued by guilt. burdened by confusion over life and death andby rampant pessimism. We can not let ourselves withdraw from what we mayconceive as our own failure, For, to the patient. this withdrawal may be mistakenfor abandonment and, in response. he can become demanding. hostile or depressed. We—the physician. the patient. the family—must be attentive, for atno other time in life is the need for human contact greater than when deathapproaches.

Many other important problems were discussed at the conference: the urgentneed to end the prudish public silence about cancer; the role of labor and industryin cancer prevention: the availability of insurance for the recovered cancer patient: programs to help the patient return to his community and his job: the functions of the American Cancer Society in providing services extending from initialinformation and counselling to rehabilitation: and the new role of the federal government in cancer control.

The Conference on Human Values and Cancer taught us that we must continueto use everything at our disposal to help “¿�theobscure men and women who dailyaccept reality with a smile and whose silent courage makes lives worthy of beinglived.― It also taught us to place human priorities above all other priorities. Thegreatest asset our country has is its people: the greatest threat to our future comesnot from bombs or missiles but when we no longer care.

19iAi4&ri-/011d.M.D.

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