Dying got so protracted and difficult it became necessary to invent the living will — a list of opt-ins and opt-outs during the last days/weeks/months. If you haven’t made one, you know you should.
What a living will does not record, because it doesn’t need to, is something we also all need to decide for ourselves, preferably as far in advance as possible. It is: what will we do if the prognosis is terminal, but we are offered chemotherapy?
It’ll mean balancing side-effects against time bought. It’ll mean a very down-to-earth discussion with the doctor. And it’ll be vitally important that we don’t kid ourselves, the side-effects may not be worth it.
Most people, according to this article, do kid themselves. In a survey, over 1,100 patients with a recent diagnosis of stage IV lung or colon cancer who had opted to receive chemotherapy were asked what their expectations of their treatment were. 69% of patients with lung cancer and 81% of colon cancer patients reckoned that a cure was “very likely,” “somewhat likely” or “a little likely”.
In other words, they misunderstood why they were receiving chemotherapy. And they’re all dead.
Doctors know that people can be unrealistically optimistic in the face of an insuperable tumour. There’s this idiotic notion that cancer is a test of character, it can be defeated by willpower (and only losers surrender, presumably). Yes, we can easily delude ourselves.
The survey also reveals that patients who awarded their doctors best scores for communication were the ones with the most wildly optimistic expectations of their chemotherapy.