Truth-telling about cancer can be a precarious path, not only for patients who are told the awful truth, but also for physicians who must convey that truth.
Rebecca Dresser: "Truth-telling is complicated."
For Rebecca Dresser, a trained medical and legal ethicist, learning she had oral cancer some six years ago proved to be a life-changing experience, in ways she hadn’t anticipated.
“Truth-telling is complicated,” she said, reflecting on what she termed her own personal “diagnostic odyssey” that turned out to be both professional and personal.
“As a 12-year-old, I learned how frightening it can be when people don’t tell you the truth,” she said. “Then as a patient, I learned how frightening it is when they do tell you the truth.”
Dresser was the final speaker in a series of lectures themed on cancer, based on “The Emperor of All Maladies,” the 2010 Pulitzer Prize-winning book by cancer researcher Siddhartha Mukherjee.
A longtime professor at the Washington University School of Law in St. Louis, Dresser told her personal story to a group gathered at Balboa Park’s Reuben H. Fleet Space Center on Wednesday, June 4.
Her presentation was based on her 2012 book, “Malignant: Medical Ethicists Confront Cancer.”
Dresser, who describes herself as a member of what she calls the “remission society,” recalled how her father had died from cancer at age 39, when she was 12.
“Nobody ever told me or my younger brothers that he was dying or what was wrong, even though we sensed it was something bad,” she said. “Whenever we got up the courage to ask our mother, we would get these vague responses that were meant to assure us – but did not.”
She continued: “So this is the way I learned that people should tell the truth about serious illness. This is the way I learned that shielding children from bad news does them no good.”
That childhood experience ultimately inspired Dresser, who holds a law degree from Harvard, to pursue her career as a medical and legal ethicist.
“Knowing about a life-threatening diagnosis may be better than not knowing, but it’s terrible knowledge,” she said. “With it comes impossible treatment choices” – both for patients and physicians who treat them.
As for her own cancer experience, she underwent extensive chemotherapy, suffered severe weight loss and was forced to use a feeding tube for several months, which resulted in slightly slurred speech.
Amid countless stories of doctors who “display shocking insensitivity” and use “terse statements and evasive language,” Dresser said, the best response she’s heard from a physician obligated to convey bad news to a patient was simple and compassionate:
“Yes, it could be cancer. But if it is, we’ll be right there with you.”
Dresser’s appearance was co-presented by UC San Diego Extension and the Center for Ethics in Science and Technology.
After her talk, Dresser was interviewed by Ethics Center director Michael Kalichman, who revealed that he is a cancer patient himself. Last year, he underwent extensive chemotherapy and surgery.
“Welcome to the remission society!” said Dresser, as the two exchanged a high-five.
—John B.B. Freeman