By Daniel B. Hinshaw, MD, FACS, University of Michigan
In a provocative article, Weeks et al. (N Engl J Med. 2012;367:1616-25) demonstrated a disturbingly high prevalence of the expectation that chemotherapy might be curative among patients with stage IV lung (69%) or colorectal (81%) cancer at the time of diagnosis and who had opted to receive chemotherapy. Denial and fear of death are powerful, often unspoken factors influencing the relationship between oncologists and their patients. Clearly, when one’s future well-being and very survival are threatened, rational discussion may not be entirely possible. Death and dying are often treated as taboo subjects for conversation in polite society; they are something akin to pornography. Nice people don’t talk about such things. Euphemisms have replaced use of the “D” word in most polite references to the topic.
A very interesting social phenomenon is flying directly in the face of this taboo. Death Cafes, the brainchild of Swiss sociologist Bernard Crettaz, are gatherings of inquisitive people in which participants discuss human mortality over cake served with refreshments. According to the community’s website, “At a Death Cafe people, often strangers, gather to eat cake, drink tea and discuss death. Our objective is 'to increase awareness of death with a view to helping people make the most of their (finite) lives'. A Death Cafe is a group-directed discussion of death with no agenda, objectives or themes. It is a discussion group rather than a grief support or counseling session.”
The phenomenon has spread from Paris and London to most major cities in the United States. In some very real sense they have created a “safe” space in a congenial environment for interested persons to discuss death. How great an impact on the pervasive taboos regarding death that such gatherings will have is yet to be seen. Nonetheless, the phenomenon may represent an opportunity for those who care for patients with cancer to engage with the public about suffering and death in a unique, non-threatening environment outside the heat of the direct battle with cancer. With this spirit in mind, ASCO is planning to host a Death Cafe at our Palliative Care in Oncology Symposium on Friday, October 24, following our general session on End-of-Life Care. We hope you will join us for some lively conversations about death in a congenial setting accompanied by pastries and a warm beverage, so that we can discover together the potential value of this new social phenomenon.