When doctors use 'battle' language, some patients lose, op-ed argues

Metaphors can be a valuable tool, experts say

Editor's note: This story was updated on January 10, 2018.

The use of so-called "battle language" in oncology and other types of care can have the unintended effect of making patients who are grappling with their illness feel like "losers," physician Seema Marwaha writes for Vice.

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Marwaha, a Toronto-based internal medicine doctor, recalls a heartbreaking conversation he had with a cancer patient who was considering medically assisted death in August: "I don't want to be remembered a loser," the patient said. "I don't want my obituary to say that I lost the battle."

That patient's sentiments may be an unintended side effect of so-called "battle language" in cancer care. Doctors, the public, and many patients embrace war-based metaphors for framing their treatment. Marwaha notes that doctors commonly say things such as "we can beat this" and "you are a fighter" to cancer patients.

Some groups have made the battle metaphor more explicit. A recent television commercial by Toronto's Sick Kids Foundation features images of soldiers lining up for battle and a declaration that "sick fights back."

The video made some people uncomfortable. Louise Kinross, whose son was aided by the foundation after he was diagnosed with a rare genetic disorder, wrote in an essay that defining sickness in such simple terms can send the wrong message. Doing so implies "that those who don't beat their illness or disability are 'losers,'" she wrote, adding, "Were they not as tough as the kids wearing the super hero costumes in the video?"

Elena Semino, a professor of Linguistics at Lancaster University who has studied the verbiage that cancer patients use to describe their experiences, says "When the [battle] metaphor is used in situations where the disease is incurable, that makes the person who is dying a loser and responsible for not getting better."

However, Semino notes that some cancer patients find war metaphors useful. Metaphors are tools, she says, and patients should choose a metaphor that helps them make sense of their experience. "When you are vulnerable and dying you should have as many tools at your disposal as possible," she said. But "when battle language becomes dominant and part of public discourse, it makes it difficult to distance yourself from it and find an alternative metaphor."

Some experts say doctors are incentivized to choose war metaphors because doing so makes it easier to communicate with patients. James Downar, a critical care and palliative care physician at Toronto's University Health Network, says framing a disease's course as a fight is easier than telling a patient, "I can't turn this around."

Oncologist Edward Halperinalso says war metaphors can prompt patients to pursue treatments that are too aggressive in some cases. "It's difficult to tell patients 'you have cancer, we are going to watch it,' even if observation is most appropriate," he said. "We may be grossly overtreating some conditions as a result."

Lori Davison, a VP with the Sick Kids Foundation, says the charity was aware that its video might touch upon some controversial issues, but added that it was an effective way to connect with new types of donors, including young people and men. The goal was to "jolt the community and make people sit up and take notice." The campaign hopes to raise $1.3 billion to support pediatric care and research (Marwaha, Vice, 10/27; Kinross, The Walrus, 10/20; Lancaster University release, 11/4).

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