Mind that gallows humour!

Michael Cook
7 Sep 2012
Reproduced with Permission

Commonly used palliative care practices are often misconstrued as euthanasia or murder, even though the treating physician may have no intention of killing a patient. One reason for this may be gallows humour, according to an article in the journal Mayo Clinic Proceedings. An online survey of palliative health care physicians found that 72% had been called Dr Death, or something similar, in the past year - mostly by other physicians, but also by family members and patients.

"What jokes illustrate about medical society is that doctors and nurses are members of a pluralistic culture that clearly contains within it conflicting beliefs about end-of-life care, specifically hastening death," says Lewis M. Cohen, of Tufts University. Because many people fear death so much, the idea that some treatments hasten death while alleviating pain can be badly misinterpreted. But Dr Cohen says that doctors should not be cowed into overtreatment:

"Even in the face of potential accusations of euthanasia or murder, clinicians ought not to be bullied into compromising their management of dying patients and won't be if they know their institution has protocols for dealing with accusations when they arise."

Still less should they stop joking around:

"Although caring for dying patients is always a serious matter, it would be a mistake to conclude that physicians ought to cease joking about death with their colleagues. Freud's understanding of humor seems newly trenchant. Levity must remain an acceptable defense mechanism in medicine for coping with the weightiest of medical duties: helping patients to die with grace and dignity."

Palliative care physicians have to negotiate the shoals of misunderstanding and the reefs of fear in an emotionally demanding environment. It's a tough gig. Most people share Woody Allen's take on the subject: "I don't want to achieve immortality through my work. I want to achieve it through not dying. I don't want to live on in the hearts of my countrymen; I want to live on in my apartment." - Mayo Clinic Proceedings, September