I had a remarkable conversation with an 85-year-old retired chemist, a woman determined to die quickly and as free of nausea and diarrhea as possible.

A friend of mine, who considers the patient almost her second mother, was worried about the fact that she did not seek a second opinion when she heard she had advanced leukemia.

The almost-daughter asked me to call the patient, with the patient’s agreement, and talk to her about how important second opinions are—especially with a life-ending diagnosis such as this one. Without treatment, she had been told, she had one to two years.

Once we had introduced ourselves by phone, she wasted not one second.

“I’m 85 years old. If I were in my 60s, maybe even 70s, I would think about treatment. Not now.”

She seemed troubled that I was concerned about her, I, a stranger. She started working to persuade me right after hello. I listened but I wasn’t calling to persuade her to do anything. My role was to be sure she knew how easy a second opinion would be to arrange at a top medical center and that I would be happy to go with her, as my friend cannot, if she wanted company. She has no remaining family.

She kept going over her reasons although I had said it was not my place to comment on her decisions in any way.

Most important, she said, was that her doctor gives me “all the time in the world. She understands what I want. Symptom control. She may be sick of seeing me come. I do a lot of research before I make up my mind. She never shows it if she is. I am very, very comfortable that she understands my goals and my decisions. She will help me.”

This is what every end-of-life patient who is mentally competent hopes for: a doctor who understands and honors final wishes.

Even when there have been extensive discussions between doctor and patient, a panicked or angry family member can push caregivers’ backs to the wall with threats of lawsuits. Little works in the patient’s favor except a committed doctor, having the right legal documents in place and a trusted person to hold firm about respecting the patients’ wishes should family members disagree. (The trusted person must hold a Durable Power of Attorney for Health Care to be able to speak for the patient if the patient cannot.)

A study, published in the British journal, The Lancet, reports on the findings of a study there about doctors’ own religious views and how it may influence how they work with their dying patients.

This is a full, free article provided by the editors because they know how critically important this subject is. One day, it will affect you and me.

The editors’ position is consistent with the standards of care for dying patients who are able to understand their situation.

They should know about all treatment options available to them, including hospice. Their final wishes must be respected, regardless of what the doctors’ religious views are.

Do read this one.

The Lancet

…”according to a new study into the role of doctors’ religious beliefs and ethnicity in taking controversial decisions during end-of-life care, published in the Journal of Medical Ethics. 3733 doctors in the UK responded to a postal survey undertaken between November, 2007, and April, 2008. Specialists in palliative or elderly care had the highest response rates. The study found that independently of specialty, doctors who are atheist or agnostic are more likely than their religious counterparts to take decisions that are expected or intended to shorten the lives of patients with a terminal illness, and are more likely to have discussed these decisions with patients judged able to have such a discussion. Conversely, doctors who described themselves as very religious were about four times less likely than their non-religious or mildly religious colleagues to have discussed the possibility of a legal course of treatment intended or expected to hasten the death of a mentally competent patient with a terminal illness.”

Citation: The Lancet, Volume 376, Issue 9743, Page 743, 4 September 2010