Solving ethical issues is critical in medical practice, especially in Clinical Oncology. Cancer is the hardest psycho-emotional test, both for the patient and their relatives. In our society, the cancer patient is often perceived as a person marked with special signs. It is good if the patient is adjusted to treatment, and their environment gives them all support. Unfortunately, more often, there is a different situation: the patient has to make painful choices, and the family does not know how to help.
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Treatment of malignant tumors carried out most often with the use of physically and mentally traumatic means puts different ethical tasks before the doctor. Here is one of them: is it ethical to act on the patient’s request of a 41-year-old woman with advanced breast cancer, who has been developed, delayed since birth, for no further cancer treatment? The doctor is fully responsible for the decision in this situation.
The object of ethics as one of the sections of philosophy is morality. Everything that is good for the patient should be recognized as moral. This good is achieved by observing five basic principles (McLean, 2016).
- Autonomy: there should be respect for the patient’s right to receive all information about his or her condition and course of treatment or, if requested, to conceal this information.
- Recognition of the patient’s right to an independent and informed decision on the health issues, including the right to choose the amount and nature of the treatment.
- Benefits: any aspirations of medical personnel should have not only professional sense but also an accurate calculation of non-harm to the psyche of the patient;
- “Do no harm”: the desire and ability of the doctor not to cause moral damage in the process of communication and preparation of the patient for the proposed decision and to do everything necessary to make it as balanced and sober as possible;
- Justice: medical professionals should strive to uphold the laws of equality, freedom, responsibility, and efficiency;
- Interdependence: all people are dependent on each other, and none of them should act alone in solving issues of life and death.
Based on these values, doctors need to decide the fate of their patients. In the case of a woman who has breast cancer, if her decision is announced, confirmed on paper, and recognized as expressed in a conscious state, ethics cannot go against the civil rights of the patient. In most cases, the patient refuses to be treated because he or she does not believe that she will be helped but understands that chemotherapy and other unsafe treatments cause irreparable harm to the body. Sometimes people can no longer live fully after the passage of low-quality treatment.
However, the doctor is obliged to make sure that the woman understands all the risks associated with her decision not to continue treatment. The specialist must explain that the result is almost always fatal at the stage of metastasis, and the woman has very little time. Also, the medical staff is required to warn the woman that breast cancer has been studied in modern science sufficiently to be likely to cure it, provided that the latest scientific advances are used (Perroud et al., 2016).
Doctors must do everything necessary to ensure that the patient has thought about everything carefully and that she is not affected by external stressful circumstances when making a decision. The conversation between the specialist and the patient should be courteous and delicate (Nobis, Grizzle, & Sodeke, 2017). The duty of the doctor is not to inspire his or her point of view to the patient but to make the final decision of the patient dictated only by objective and compelling reasons.
Another critical point in the negotiations with the patient is the degree of family involvement. It is necessary to find out whether a woman has close relatives, such as parents. It is worth asking if her family knows about the decision she is willing to make. However, in this matter, the doctor should be especially careful: perhaps the patient made such a decision precisely because of the lack of family or because of problems associated with it. In most cases, family ties can save even the terminally ill if the patient has somebody to live for, but otherwise, they become an aggravating circumstance, especially in the case of a congenital disease.
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If it happens that the patient remains firm in her decision after all the arguments of the doctor, only in this case, the doctor can fulfill her will and not continue treatment. Perhaps, since the woman has a developmental delay since birth, she is tired of fighting her body. This is especially possible if she is used to thinking she is defective because of the cruelty in society. Delays in development do not mean that this person is not able to understand what is happening around and does not identify herself as an individual. From that moment on, the doctor cannot be held responsible for her conscious choice.
McLean, S. A. (Ed.). (2016). First do no harm: Law, ethics and healthcare. New York, NY: Routledge.
Nobis, N., Grizzle, W. E., & Sodeke, S. (2017). Bioethics and cancer biomarker research. In S. Srivastava (Ed.), Biomarkers in cancer screening and early detection (pp. 277-282). Hoboken, NJ: Wiley-Blackwell.
Perroud, H. A., Alasino, C. M., Rico, M. J., Mainetti, L. E., Queralt, F., Pezzotto, S. M.,… & Scharovsky, O. G. (2016). Metastatic breast cancer patients treated with low-dose metronomic chemotherapy with cyclophosphamide and celecoxib: Clinical outcomes and biomarkers of response. Cancer Chemotherapy and Pharmacology, 77(2), 365-374.