Just Say Die

As a medical oncologist, I spend most of my time treating people with incurable cancers. Depending on the person and the specific illness that person has, that question may come on the first visit with me or on the tenth: “How long have I got?” It may come out of the blue or as part of a larger discussion about the progress of their disease. I will say, “It may be only a few months until the end ” or “until you pass away, ” but I rarely say exactly what I mean: “It’s only going to be a few months until you die.” Die is a short, simple word. The problem is that I rarely use it when I speak to my dying patients, and I don’t think I’m alone. Quality end-of-life care is an ethical imperative, and improving conversations about the end-oflife is an important part of improving that care. Although it’s acknowledged that discussions about dying are important, little has been written about the words we use during these discussions. I would like to examine why it is so difficult for physicians to use the word “die,” and why it may be so important that we use it more often.