Though I try to avoid television as much as possible, I must admit I’ve watched more than my fair share of legal shows. Since the minor cases wouldn’t make for interesting viewing, murder trials seem to be the norm. And every time they show the jury diligently listening to testimony, absorbing information, and ultimately deciding the defendant’s fate, I wonder how I would fare in such a situation. Would I be able to stay awake? Would I actually be able to disregard a statement if the judge so ordered? And when it came down to sentencing, could I ever support a sentence of death, even for the most heinous crime?
And yet, though I have no idea how I would react to the prospect of a courtroom death sentence, as a trauma and general surgeon I have given death sentences more often than I’d care to remember. Telling a patient he has an advanced, inoperable tumor that will kill him in months; informing relatives that their beloved has suffered devastating injuries that are not survivable or that an infection is so severe that it is insurmountable. These are the most difficult conversations to hold and I never know exactly what I’ll say until I find myself listening to the words spilling out of my mouth. But no matter the circumstances I am always thorough, direct, and brutally forthright.
I owe it to my patients and their families to give the truth, the whole truth, and nothing but the truth. Every bit of it, no matter how bad it may be. I always warn people before I start that what I’m about to say may come off as abrupt or rude, but that is not in any way how it is intended. I simply don’t beat around the bush, I don’t sugarcoat the issue, and I don’t pull punches. I never tell anyone with an advanced cancer that surgery will cure him. I don’t make guarantees to my gunshot victims that their surgery will be successful.
In other words, I don’t ever give false hope.
So it came as a great surprise to me when I first heard furor regarding the Medical Innovation Bill in the UK several months ago.
Lord Maurice Saatchi introduced the bill to parliament in 2013 after his wife, Josephine Hart, died of ovarian cancer in 2011. He felt that doctors were constrained by fear of litigation to try anything new to help his wife’s relatively rare disease, so after she succumbed he proposed the bill in hopes that it would ease doctors’ fears and allow medical advancements to proceed more rapidly.
The Saatchi Bill, as it is now colloquially known, stipulates that after being given consent by their patients and consulting with a multi-disciplinary team and one other doctor (who would not necessarily have to agree with the treatment), physicians would then be given free rein to try untested and/or unproven treatments on their patients. The law would prevent patients from suing the physician if something went wrong or the treatment was ineffective. It would apply not only to difficult cases like rare cancers with few effective options, but to any medical condition.
So without fear of litigation for bad outcomes, doctors (so the hypothesis went) would feel unconstrained to try new things, thereby speeding up the rate of discovery. And this, according to supporters of the bill, would allow doctors to “innovate new treatments and cures safely and responsibly for cancer and other diseases.”
That in turn would give patients hope. And hope is good.
Who could possibly be against such a bill of hope? No one except the Grinch, right? Actually, maybe you’ve heard of some of these organizations:
• Royal College of Physicians • Royal College of Surgeons • British Medical Association • Academy of Royal Medical Colleges • Association of Medical Research Charities • British Pharmacological Society • Cancer Research UK • Motor Neurone Disease Association • NHS Litigation Authority • Royal College of Psychiatrists • General Medical Council • Royal College of Radiologists • Academy for Healthcare Science • The Patients Association • Medical Defence Union
It’s telling that every one of these groups came out against the bill, and even more telling that the bill was subsequently killed on March 6. But think about it this way—when have you ever seen doctors and lawyers agreeing about anything? Is it a vast conspiracy to suppress alternative treatments?
No, there is a much more mundane reason for opposing the Saatchi Bill: false hope.
The fact is, we live in a real world with real problems and real diseases, not a fantasyland where ultra-diluted water or high-dose vitamin C or an alkaline diet can cure any disease or stimulate the body to do so. In this world, real scientists work tirelessly researching innovative treatments for everything from benign diseases like eczema to the most hideous rare cancers. That is how new treatments are developed—not by doing coffee enemas and crossing your fingers.
The Saatchi bill, despite the proponents’ arguments to the contrary, would have been a charlatan’s dream. It would have unfettered unscrupulous doctors to use unproven and/or expensive treatments like antineoplastons, radionics, the pH miracle cure, Gerson therapy, and the like with impunity. None of these has any proven benefit, but quacks could have used any of them under the protection of the bill to defraud ailing people who are already at their most desperate and susceptible.
Before anyone accuses me of trying to kill hope, let me make one thing perfectly clear: Hope is good, but only when it is warranted. For uncomplicated cases of appendicitis, I always tell people the risks, but I also understand—and make the patients understand—that those risks are relatively small and that I expect a full recovery. On the other hand, if I get a septic elderly patient with a perforated colon, I will tell the patient and family that I will do my absolute best to get them through this, but the risks are high and I make no guarantees.
I am in the unenviable position of seeing this time and again in my sick and dying patients, and invariably the ones who do best are those who accept their diagnosis and do what can be done. But the only help false hope can provide to desperate people is avoiding the reality that the world isn’t always kind or fair. The truth can be a bitter pill to swallow, but once we accept that truth the healing can start, figuratively if not literally. Otherwise people continue their false hope to the end, always hoping, but never improving.
“They have killed the Medical Innovation Bill,” Lord Saatchi said after the bill was killed by Parliament. “It is dead. By killing the bill they have killed the hopes of thousands of cancer patients.” But hope comes with an expectation that something good might, though not necessarily will, happen. When that hope is false, when even the hint of a promise is empty, that “might” vanishes, and it can be truly devastating. This serves to make an already difficult situation that much worse.
We’re here on this planet for a short time, and when some combination of fate, bad luck, bad genes, and bad choices make that time even shorter, no amount of false hope will help. Acceptance allows us to move on and enjoy the time we have left with the people we love.