My patient was a bright 80-year-old lady who had been the administrative assistant at a large corporation

Everyone knew she basically ran the show when she become ill. She was diagnosed with a form of bone cancer and underwent treatment.

When I began to see her, she had already begun extensive chemotherapy, yet she always seemed upbeat and optimistic.

But the reports from her oncologist were not encouraging. I began to feel a bit disconnected from her disease and its implications in my role as her cardiologist.

So I called her out-of-town specialist to ask about her disease and its prognosis.

The oncologist told me the patient had less than six months to live. I asked him if he had told our patient.

“No, of course not,” he said. “I don’t think she is ready to hear that news.”

At her next visit, she came with her two grown children. I had a chance to speak with both of them outside the room.

“No,” her daughter said, “we don’t want Mom to know the truth. It would kill her.”

Her son disagreed. He felt strongly that their mother had a right to know and to make plans for the end of her life.

This disagreement had already shattered the family unity. The resulting stress engulfed us all. And the patient was simply caught in the middle.

I’m convinced that she knew her time was nearing its end, but she remained a warm, interesting and loving person. My intuition told me that she had come to terms with her mortality.

So what should doctors do in a case like this?

According to the American Medical Association’s panel on biomedical ethics, one of the four cornerstones of any decision-making is patient autonomy.

This states the obvious — the patient should always remain at the center of decisions. Our moral contract is with the patient, not the children or spouses.

The issues are often blurry and despite our best intentions, telling the patient an important fact may lead to conflict and poor outcomes.

So should we temper our truth-telling to keep families together? Should we be less than frank about a dismal prognosis to protect the emotional state of the patient?

Or does each patient deserve the truth so informed decisions can be made?

Unfortunately, such choices increasingly common in our health care system.

As care has become more fragmented between multiple specialists and primary care physicians, it seems as if no one is helping patients and their families cope with these difficult decisions.

Studies show that patients tend to hear what they want. Some want hope; others want unvarnished truth.

Hope is often a strong variable and we know that it can positively improve many forms of treatment.

In his classic book, “Anatomy of Hope,” Dr. Jerome Groopman writes that talking about the grimmest of situations in hopeful terms is often the wisest and kindest thing we can do for our patients.

He doesn’t recommend glossing over the truth, but telling it in language that opens the door for hope.

Still, we are often left with impossible choices — giving patients hope, telling them some hard truths, or appeasing family who may be at odds about what to do.

It is a delicate balancing act that often is not science, but medicine at its most artistic and agonizing.

Michael Attas is a local doctor, medical humanities professor and an Episcopal priest. Contact him at Michael_Attas@baylor.edu.