Medicine: Prescription for Dying

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When a patient is dying—whether from inoperable cancer in the prime of life, or from a degenerative disease of old age—Dr. Walter C. Alvarez prescribes kindness in two forms: frankness and indulgence.

Dr. Alvarez, 66, famed Mayo Clinic diagnostician, is editor of GP, monthly journal of the American Academy of General Practice. Addressing general practitioners in San Francisco last week, Alvarez counseled against lying to a dying patient or keeping up a cheerful farce for his supposed benefit. In one way or another, the patient usually finds out or guesses what his condition is, and then his miseries are increased by annoyance at the dissembling physician. Sometimes the victim is not so much appalled by impending death as he is by the prospect of leaving his wife or husband. In that case, Alvarez talks frankly to both: "You two know perfectly well what this disease is, so why should you now be lying to one another, as you never did before? Why not now face this hardest of all things together?"

If there is pain, Alvarez believes in giving drugs to the dying patient with the utmost generosity. What if he does become addicted? It will make no difference in his grave. Moreover, naked suffering brings on death more quickly than morphine and other analgesics do.

Alvarez does not prescribe diets for old people except in cases of absolute necessity (e.g., diabetes, severe gout, swelling of the legs). In general, he believes in letting oldsters, whether healthy or ill, eat, smoke and drink what they like. He told of two middle-aged women who brought their spry, neat, 80-year-old father in to see him. Another doctor had found a little high blood pressure, and had deprived the old boy of his pipe, his bedtime highball, his red meat, his table salt, his puttering in the garden and his strolls around town. The father had rebelled and the women wanted Alvarez to back up the other doctor.

Alvarez refused. He assured the women their father would very likely die all the sooner if deprived of his comforts, and have a worse time over it.

"When I myself lie dying," said Dr. Alvarez, "I hope I will have by me some wise, kindly physician who will keep interns from frequently pulling me up to examine my chest, or from constantly puncturing my veins, or from giving me enemas or drastic medicines. I am sure that at the end I will very much want to be left alone."