NEW YORK—What does it mean to be a doctor given that no matter how great you are at it, all of your patients are going to die—unless you die first?

It is not an easy, ego-gratifying question. But Leslie Blackhall, MD, director of the Center for Geriatrics and Palliative Medicine, University of Virginia, Charlottesville, believes it is one all physicians ought to ponder.

Speaking at the first International Conference on Asian Therapies for Cancer, Dr. Blackhall held that physicians’ denial of their own mortality, coupled with an insidious insecurity about clinical proficiency and fear of lawsuits can result in much unnecessary suffering for patients, especially those at the end of life.

“Good research shows that more than 50% of cancer patients die in pain, after receiving totally useless and humiliating medical interventions. They are completely useless and everybody knows it.” But for some reason, doctors, patients and family members alike feel the need to “try.”

Dr. Blackhall believes that reason lies in a deeply held cultural attitude that death is something extrinsic to life, something that is not supposed to ever happen. This view has wide ramifications: it underlies the mad search for “causes” of death; it fosters the adversarial, militaristic model of care that has led to the expensive, but largely unsuccessful “wars” on cancer and heart disease; it creates a feverish game of “not my fault” in the halls of the nation’s hospitals.

“Half the reason people end up in the intensive care unit, is because by putting them there, the doctors and the family members can all say, ‘It’s not our fault. We did everything.'”

Modern medicine’s emphasis on biochemical “causes” has clearly provided insight into the processes that contribute to disease states. But it also provides convenient ways for doctors to avoid the very human condition we all share.

Leslie Blackhall, MD, director of the Center for Geriatrics and Palliative Medicine, University of Virginia, Charlottesville.

“When a 31-year old woman with breast cancer asks you, ‘Why me?’ Telling her that it is all due to the BRCA 1 gene is really no help,” said Dr. Blackhall, who has a master’s in theology from Harvard Divinity School, and has studied Tibetan Buddhist medicine extensively. Likewise, uncovering the genetic “root” of alcoholism or addiction won’t help you help a family deal with its interpersonal impact.

Medicine’s technology offers a lot of hiding places from mortality. “We put the patients on ventilators and then we can worry about the vent settings instead of facing our own mortality.”

Unwillingness to reckon with death is not the sole province of high-tech allopathic medicine. Dr. Blackhall finds it in the “complementary and alternative” world, as well. “There are these sneaking presumptions that somehow, if you just eat your broccoli and meditate and take your antioxidants, you will somehow be able to avoid it.”

She also sees fear of death in some of the ways people try to integrate meditation, mind-body techniques, and spiritual disciplines into medicine—especially when it comes to working with cancer patients. She urged colleagues to remember that, “the purpose of enlightenment is not to heal cancer; the purpose of healing cancer is to give you enough time to find enlightenment.”

Obviously, physicians must commit their skill and effort toward reducing suffering and prolonging life. But Dr. Blackhall believes they must also know when their actions are futile and come from the desire to avoid appearing powerless.

In the struggle to prolong life, doctors and patients alike can lose touch with the most crucial question: what are we each living for? There are no simple answers, and the question may not lead to definitive clinical action plans. But it is one that is shared by every human being, one that can remove the rigid though invisible wall between you and your patients, and between patients and those close to them. Dr. Blackhall believes there is healing power in that.

“We as health care professionals need to be present with our patients in their mortality. If we think of death as this unfortunate thing that only happens to a small number of people, then we have a very seriously distorted world view.”