A few days ago I was listening to a conversation between two therapists, a physical therapist and a speech therapist. They were discussing the moral and ethical implications of treating a patient with a brain tumor or other similar incurable diseases. They were agonizing over what to tell a patient who is reporting for hours of therapy when they were near death. The speech therapist argued that she often wanted to tell patients to go home and enjoy their last few weeks with friends and family rather than waste precious hours in multiple therapies each day. It made a lot of sense to me. And then I read a short blurb in the health section of the Washington Post. A man had written in saying that he had been diagnosed with the Acquired Immunodeficiency Syndrome and that he is still alive more than thirty years later. Three decades is much longer than the medically accepted life expectancy. So here is the dilemma as a therapist: how do you decide what is hopeful and preparing your patients for their futures and what is fantastical thought that should be replaced by practical steps to ensure maximum quality of life. I have a feeling that it is one of those questions that will never be fully answered but must be addressed anew each time such a patient comes under our care.
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