Trying to conceal the truth about cancer from the patient is like trying to hide an elephant under the living room rug.
What makes the tragedy of concealment ironic is that no one has ever succeeded in doing it. I have seen a husband trying to conceal the truth from his wife while she is trying not to reveal that she knows the truth. The amount of energy wasted in this futile deception could be spent in the couple supporting one another in a myriad of ways. Instead of helping each other to face their respective losses, many people (and their physicians) try to conceal the truth. To lie successfully under these circumstances is something that a professional actor would have trouble with; yet doctors and wives and husbands delude themselves with the thought that they are really carrying it off.
There are very few things that I am sure of; one of them is that concealing the truth from an adult with incurable cancer is usually disastrous. There is no point in the macabre conspiracy of silence. The patient knows, or can guess, how ill he is. This being the case, all of the efforts at concealment are wasted. Added to this is the patient's feeling that there is no one whom he can trust and talk to, and that he has to protect those around him from the truth that they are protecting him from (sic); a truly Gordian Laingian knot. The consequences of concealment are more pain rather than less and considerably less love and comfort for everyone involved.
I do not mean that the truth should be forced upon someone. When a person is ready for the truth, he will ask. When he does ask, he should be told the complete truth, and there should be a loving shoulder nearby to cry on. Who does the telling depends upon who is able to. If possible some one should be on hand who has accurate information, but it is not necessary. The important thing is to have someone who cares. I have seen whole families handle the problem together, and all have been drawn closer to one another as a consequence.
People who faced impending death openly have found that their remaining time together was among their best, while those who concealed were continually fearful lest "he should find out." One would think that not being too close would make the parting easier (if you're farther apart you won't care so much) but it doesn't. It only adds an additional burden of guilt for not having done more to make the patient's remaining days happier. It is so much better to tell someone that you love him and don't want him to die, than to have to say it years later to an empty chair in a therapy session.
There is one more important reason to make it a policy to tell the truth. If someone does not have cancer, they will believe you, instead of wondering what is being concealed.
The relationship between patient and doctor can also be an open and honest one. I believe that the most rewarding relationship between patient and doctor is one where the patient is treated as the equal of the physician in everything but the physician's professional expertise. In short, the doctor should treat his patient with the same respect that he expects from his automobile mechanic. On this basis, the patient may be able to make both an intelligent and informed decision about his own life.
The physicians I have known whose professional activities have enriched their own lives have been those who prefer this way of dealing with their patients. Making life and death decisions for others can lead to many a sleepless night, while helping others to make their own decisions can be very gratifying. Doctors who perpetually make decisions for others are often continually agitated and spend the better part of their lives running from office to hospital to golf course and back again.