In end-of-life discussions, humanity should be more important than efficiency.
When Ernest Quintana went into the hospital last week, his family knew he was very sick. He’d been suffering from chronic obstructive pulmonary disease (COPD), in and out of the hospital several times recently, and his loved ones knew he might not have long to live. They expected that they’d eventually receive bad news from the doctors.
What they didn’t expect was to have that bad news delivered via a mobile video screen on a stand that rolled into Quintana’s room alongside an unspeaking nurse. From a remote location, a doctor told Quintana and his granddaughter, Annalisia Wilharm, that his treatment options had run out and he would be placed on palliative care there at Kaiser Permanente Medical Center in Fremont, California.
An appalled Wilharm captured the conversation on video, documenting the scene as her beloved grandfather was told he was about to die by a talking head on a monitor. The news quickly went viral (read more from the Mercury News) and opened a nationwide conversation about compassion — or a lack thereof — in medicine.
Telemedicine is on the rise, allowing patients access to doctors in new ways and from remote locations. Patients can consult physicians from home or from small medical facilities. They can have access to highly skilled doctors even if those doctors don’t practice near them. In many cases, it’s an incredibly useful application of videoconferencing technology.
But is there anyone who would choose to be told they’re going to die by a talking head on a video screen?
When the monitor was brought into Quintana’s room, his wife and daughter were away, having stopped at home for a quick break from keeping watch by their loved one’s bedside. The terminal diagnosis was delivered without them there, by a doctor no one in the family had ever seen before. These disconnects added to the family’s unsettling experience.
“I wanted to throw up,” Wilharm told reporters. “It felt like someone took the air out of me.”
It’s easy and natural for us to feel seduced by the technological advances in recent years that have made “face-to-face” communication possible across vast distances. Video meetings allow us to collaborate with far-flung colleagues with ease, seeing their faces and sharing our screens as we work and present charts and images and videos. At home, we can video chat with loved ones at the touch of a button, feeling close despite the miles between us.
Still, anyone who’s video chatted with a faraway friend knows there’s a vital piece missing from those chats, and that’s their physical presence. As intimate as a video chat might feel, it just isn’t the same as an in-person conversation.
Often, that’s no big deal. When family, friends, or coworkers are hundreds of miles away, we do what we can to communicate. Even if it’s not optimal, it can still be pretty good.
But is there anything at all good about receiving the worst news of your life in such an impersonal way?
Quintana’s daughter, Catherine Quintana, certainly didn’t think so. “It should have been a human,” she told the press. “It should’ve been a doctor who came up to his bedside.”
There’s a line that was crossed here. We might not have known just how problematic this would be until the first time it actually happened, but it turns out that it’s not okay for the news of someone’s imminent death to be delivered by a face on a computer screen. As revolutionary and life-saving as telemedicine might be in the right situation, it can lack the essential humanity and compassion that a real live person has.
Compassion is conveyed via hundreds of tiny cues that just don’t fully come across on a computer monitor. And when it comes to the end of a life, compassion is one of the most important qualities for everyone from family and friends to medical personnel to have.
It was missing from Quintana’s final diagnosis. He died two days after the video conversation, and that will forever be what his family remembers about his last days.