Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Abstract

The topic of death and dying arises frequently in surgical practice, yet represents one of the more challenging areas for many surgeons. Surgeons must feel comfortable addressing the issue of death whether it is a theoretical concern in the context of routine informed consent or an inevitable reality in the setting of end-of-life care. In the palliative setting, four essential elements must be present in order to properly address death and dying: compassion, communication, clarity, and closure. The skills set for optimally dealing with this topic in a surgical practice must not be assumed, but fortunately can and should be learned and nurtured during education and training and beyond. This will help ensure that Surgery as a profession maintains its commitment to leading the public discourse regarding death, surgery, and patient-centered policies that inform and protect.

Hints and advice on end‐of‐life communication in the ICU, also during pandemics

“…Points 1-9 concern pre-conference preparation and being (mentally) prepared to handle life and death issues. 10 Undisturbed surroundings for communication during busy pandemics may be impossible to find, but the eight other points are universally applicable whether there is a pandemic or not. Conferences are not a mere information forum.…”

“…20 Using the word 'death' may seem intimidating but is honest and trustworthy communication if EOL is a possibility. 2,10 Points 20-22 concern ending the conference. Summarize the major points and clarify to the participants what will likely occur next.…”

“…Many physicians hesitate to talk about death for fear of patient distress. 10 This concern appears unfounded by research.…”

“…TA B L E 1 Results of the literature searchesTA B L E 2 Hints and advice on communication in the ICUFramework for ICU conferences with patients/relatives 1. Make sure you are mentally prepared for the conference 10. 2.…”