Choices

I have thought how devastating it must be for an oncologist to give a horribly toxic treatment to a seemingly strong patient, totally destroying the quality of their life, only to find it ineffective and watch the patient die. That physician not only has my sympathy, but my admiration, providing the treatment was given with the patient’s complete understanding and at the patient’s request.

The only important factor is quality of life. Without quality of life, there is no point living. But examine what quality of life truly is. Supposedly, Lady Di tried to commit suicide several times. Here was a beautiful, healthy, wealthy lady with ostensibly everything anyone could possibly want. She felt the quality of her life was not worth living.

I know from personal experience that when I was told I was terminal with 90 days to live and nothing could be done, my quality of life sank to an all time low. It became nonexistent. When I was told there were treatments that could help, I was elated. Even when I was being made deathly ill by the chemicals, the quality of my life was far better fighting to live than waiting to die.

Therefore, whose decision should it be to forgo treatments to retain the supposedly current quality of life or to go for devastating treatments to immediately make an individual ill with uncertain chances of helping. It is no one’s but the patient! But that must be a well informed patient.

Let’s examine a few of the possibilities. Research has shown that a not-so-small percentage of cancer patients have a desire to die. To give these people a treatment of any kind other than to make them feel better currently would be against their wishes. Some people have a desire to live but they are frail without a long life expectancy. If pleasant treatments could serve a purpose, that would be the extent of their participation. Some are young and vibrant, regardless of age, with much to look forward to. These people want to try anything that offers any possibility of surviving. It is their right to receive it.

It is never the physician’s decision to make. It is not a family member’s right to make except in the case of a patient who can not think for themselves such as an infant. It is the patient’s right exclusively. The physician has the responsibility of explaining thoroughly the ramifications of the disease and the possible treatment options so that the patient and family truly understand. The physician and the family even have the right, if not the duty, to try to talk the patient into wanting to take treatments to try to live. But the final decision is up to the patient, no one else.

A cancer patient appeared very depressed at a meeting. Upon questioning, it was learned that he had received the state-of-the-art treatment for his disease without success and had been told six months before this meeting he was terminal and nothing else could be done. That was the last time he had seen his doctor. He is slowly wasting away. But it is not that he is just wasting away. Any conceivable quality of life he and his family had ceased on that day six months before. There were many other options available, none of which were as good as what had been taken. The physician, in order to “spare” him suffering, made the unilateral decision and taken him off all treatment. Had the doctor talked to this man and explained the situation instead of making the false statement that nothing else could be done, there is no doubt that treatments would have been tried. Whether they would have been successful or not is an unknown, but the fact that the quality of life would have been far improved is indisputable.

Another possibility here is that this is not what happened at all. Possibly the physician offered numerous other treatments and the patient declined. However, that really doesn’t matter. The patient understands that he was told the treatments did not work, there was nothing else that could be done, and the patient never saw the doctor again. Therefore, what was said or done is not the critical aspect. All that matters is what the patient understands. That is why it is so vital that the physician explain all aspects of the disease and the treatment options so that the patient can make an informed decision. The key word here is informed.

There is no such thing as false hope for a cancer patient. Hope is as unique with each individual as a fingerprint. For some it is the hope to make a complete recovery. But it might also be the hope to die peacefully; the hope to live until a specific event happens; the hope to live with the disease; the hope to have their doctor with them when needed; the hope to enjoy today. Just as each case of cancer is unique, each person is different. Each individual has the right to decide for themselves.

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