Hope for the Best, but Plan for the Worst While President

Opinion|Hope for the Best, but Plan for the Worst While President

Joe Biden’s metastatic prostate cancer diagnosis, coupled with revelations about his decline in recent years, has renewed chatter and anxiety about the former president’s health. The concerns being discussed — what’s been going on, for how long, and what should have been done? — often arise when someone receives a serious illness diagnosis. The hardest question is about prognosis — what will happen now?

We don’t know much about Mr. Biden’s situation. We know that the cancer is aggressive, and that it has spread to his bones. This isn’t enough information to tell us when the cancer started, or how it will progress. What we do know, however, is that metastatic prostate cancer is considered treatable, but usually not curable. We also know that Mr. Biden is frail, and that frailty — an accumulated loss of resilience to bodily insult and injury — makes cancer, and cancer treatment, harder to withstand.

This isn’t unique to Mr. Biden, who is 82. It’s a fact that applies to anyone in a similar circumstance, including many of his former colleagues in Congress who continue in their roles despite advanced age and health struggles. As a palliative care doctor, I wait to discuss the prognosis until a patient is ready. But when it comes to the people running the country, these conversations should be approached with compassion, not patience. Avoiding a clear understanding of what a health change might mean is an evasion of responsibility.

That’s the real connection between Mr. Biden’s diagnosis and the concerns about his gait, cognitive lapses and reported fatigue. The cancer news doesn’t tell us much about what caused Mr. Biden’s decline, or imply that a diagnosis was covered up. Rather, it gives us insight into how he might fare through serious illness.

A person’s prognosis, whether they have aggressive cancer or another disease, is informed by their overall health, the treatment they receive, their ability to tolerate that treatment, and, importantly, their priorities. I saw a patient this week who plans to decline cancer treatment in favor of traveling to his home country to spend time with his family. As a result, his life expectancy is shorter than it might be. His decision is not wrong; it’s extremely personal.

Being able to make such a choice requires forthright information from one’s physicians, and a willingness to hear that information. It’s true that there are many 82-year-old men with metastatic prostate cancer who might reasonably expect to live for years to come — to die with cancer, not from cancer. Mr. Biden might die of some other cause. Medicine has made incredible strides in the past decade in treating metastatic cancers and mitigating the harms of cancer therapies. This is especially true of prostate cancer.