When talking about individuals experiencing severe illness, people often say that they are engaged in a "battle" with a disease. Writing for NPR's "Shots," Marc Silver explains why this language should be avoided and suggests different ways to frame these conversations.
In conversations in the media, or with friends, family, and coworkers, it is common to hear people refer to an experience with severe illness as a "battle."
Countless obituaries of both celebrities and noncelebrities contain language like, "lost the battle with cancer."
Last month, the family of Bruce Willis revealed that the actor has been diagnosed with dementia. Following the announcement, media outlets circulated headlines like, "After a 'battle' with aphasia Willis is now in a 'battle' against dementia," Silver notes.
"We all know that in a battle there are winners and losers," Silver writes. "But how do you defeat a disease like dementia? It is a relentless, persistent thief, robbing a person of memory and cognitive abilities."
For some cancers, there are effective treatments that help some patients go into remission. Others, however, die from the disease. But that does not mean they failed to "fight a good fight," Silver writes. In some cases, none of the available interventions, including drugs, surgery, and other therapies can stop the disease's progression.
Still, "people cling to the language of battle," Silver writes. "They want to be a fighter, to do all they can to beat a disease."
When asked how people can discuss illness without including battle metaphors, Sunita Puri, the director of the hospice and palliative medicine fellowship at the University of Massachusetts, proposes that we think about illness as we would other life experiences. "It really is an experience," Puri said. "We don't always know what's going to happen next."
If a patient tells Puri they are a fighter, she asks them to elaborate. "I will ask people to tell me what being a fighter means to them, what's been hard about it? Has it been empowering?" she said.
Ultimately, Puri does not want people to set themselves up to feel like they have failed — regardless of their outcome. "I tell people that the strength you bring to this situation is not necessarily the strength your body can bring."
Separately, Lillie Shockney, the University Distinguished Service Professor of Breast Cancer at Johns Hopkins University School of Medicine, offers that we use the word "advocate" to replace fighter.
Shockney, who is a two-time breast cancer survivor, says that someone with breast cancer "is taking on the challenge to advocate for the right treatment at any given time."
"She also must have goals of care defined for herself. These goals need to be realistic too. So, if the goal is a miracle and she is doing aggressive treatment toward the end of life, then she [may] not just be disappointed but [may] die sooner and in a miserable way. Twenty-three percent of patients with solid organ tumors die in an ICU on a ventilator," she says, typically because "there was no thoughtful, honest discussion between the doctor and the patient."
According to Silver, patients with severe illness and their families can still find "moments of joy, large and small."
After Silver's mother-in-law was diagnosed with pancreatic cancer, she found out her tumor was inoperable. Her doctors informed her she could undergo a yearlong regimen of chemotherapy. However, when she asked about the potential result, they told her she could feel terrible from the treatment and would likely die despite their efforts.
Ultimately, she opted out of chemotherapy. At the time, their family questioned her choice. "Maybe she wasn't fighting her battle with the best arsenal of weapons," Silver writes. "But she was a realist. And she didn't want a year of feeling like crap with little to no chance of living longer than she'd live without the chemo."
While she did not receive any treatment, the pain from the cancer temporarily eased. For the next year, she was able to spend time with family, take classes, and enjoy her new hobby of painting.
Then, her symptoms returned, bringing pain along with them. After spending a few weeks "barely conscious, she died peacefully," Silver writes.
"And you know what?" he adds. "I think she won her battle against her cancer." (Silver, "Shots," NPR, 2/28)
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