Lieff, J. (1982). Eight reasons why doctors fear the elderly, chronic illness, and death. The Journal of Transpersonal Psychology, 14(1), 47-60.
Jonathan Lieff, author of this article, holds a B.A. from Yale College and an M.D. from Harvard Medical College, and is board certified by the American Board of Psychiatry (Ages Health Services Inc., 1996). When the article was published in 1982, Lieff had developed services for elderly, handicapped, and terminally ill patients in connection with the Boston Housing Authority, nursing homes, and hospitals. He had also served as Director of Geriatric Fellowship at Boston University and Chief of Geriatrics at Lemuel Shattuck Hospital, a Tufts University Facility. In this paper, I summarize the article and offer comments about selected aspects, identify some relevant changes that have occurred since the article was published, and suggest areas where additional research findings would assist in understanding the current state of medical care in regard to the issues raised. Article Summary Lieff described recent (at the time of publication) research findings that indicated “widespread and well-documented prejudice” (p. 47) against elderly and terminally ill patients, and that suggested prejudice and avoidance behaviors were fostered in American medical schools. Lieff also documented benefits of © Dawn Drake, 2008
1 psychological support for dying patients and then identified and discussed eight reasons to explain the “fear” (p. 47) that he believed could explain doctors’ behaviors toward these patients. Many of his explanations reflected spiritually related problems that he believed were at the root of the issue. Lieff (1982) did note that some medical professionals, mostly not physicians (i.e., nurses, social workers, therapists, and some physicians who find personal reward in providing elder-care), countered the norm by providing more effective services to the elderly. After discussing the relevance of the spiritual needs of the dying, Lieff (1982) concluded by positing the need for an increased professional emphasis on the “psychological and spiritual considerations” (p. 59) of the final stage of life. Critical Reflections The dominant purpose of this article seems to be to convince the reader that Western doctors (specifically, American doctors) were not prepared to support the emotional and spiritual needs of the patients who were dying, and further, that spiritual training should be included as a standard component of medical training for doctors. All of the reasons for fear that Lieff discussed reflected psychological or spiritual issues; consideration of other contributing factors was noticeably lacking. Although Lieff offered persuasive ideas to explain why doctors might “fear” chronically ill and terminal patients, many of his descriptions of doctors’ attitudes and experiences included neither research references nor acknowledgement that the statements were his opinions—presumably based on his experiences in the profession, but opinions, nonetheless. Examples include assertions that many
© Dawn Drake, 2008
2 doctors did not recognize the human potential to transcend physical limitations and find personal fulfillment, that doctors lacked resources for finding philosophical insights into the purpose of death and the dying process, that most doctors were not prepared to deal with the impact that religious beliefs or experiences had on the efficacy of medical treatment, and that our society had given doctors “a kind of priestly status” (p. 58). Acknowledging his comments as opinions or personal observations and then explaining his reasoning could have provided an opportunity to persuade a skeptical reader to agreement. By offering neither research findings nor personal reasoning, Lieff potentially increased the reader's resistance to his arguments. Numerous statements also seem to express...