The issue of ethics has a special place in cancer practice. This is due to the fact that there are practically no situations of self-recovery in cancer, and the patient’s recovery depends entirely on the competence of the doctor and the desire of the patient himself. Public fear of malignant tumors is exceptionally high because there is a widespread belief that treatment is ineffective. Therefore, many cancer patients see no further prospects, and hopelessly refuse treatment. This paper focuses on the ethical side of the question of whether it is right to continue treatment without the consent of the patient, in particular, a mentally disabled woman with breast cancer.
Cancer is a severe stressor for the patient and his or her family, resulting in psychological trauma, not necessarily related to the physical condition of the sick person. Cancer patients are in an extremely difficult situation: the treatment requires the mobilization of psychological and financial resources, and the disease leads to a significant depletion of the body. Existing medical illiteracy among the general population and the latent symptoms of carcinoma often lead the patient into a climate of complete desertion; that is why most patients are exposed to depression (Bhattacharyya, Bhattacherjee, Mandal, & Das, 2017). In these psychological conditions, patients are often inclined to refuse further treatment.
Refusal from further treatment and surgery is not uncommon in oncology. Despite strict recommendations from surgeons, approximately one percent of patients with such a diagnosis refuse treatment and even evidence-based diagnosis (Gaitanidis et al., 2018).
Behind these solutions, there is often fear of medical intervention, a stubborn decision to try folk therapy, disbelief in the possibility of healing and distrust of doctors. Of course, the patient understands the need for treatment, but his fear dominates over rationality, and in the end, he does not find the courage to make a decision. To prevent subjectivity in refusing treatment and to address all ethical aspects of this issue, most cancer clinics collaborate with psychological rehabilitation centers to provide the necessary support to patients.
Mental retardation of this woman complicates the decision to grant or deny a request to stop treatment. It is not uncommon for a patient to be unable to express his or her will regarding therapy in general. Then the responsibility for determining the abilities of the patient for his or her own decisions lies with the attending physicians and the clinic. Some methods are standard among doctors to encourage patients who have previously refused treatment to reconsider their decision (Connor, Elkin, Lee, Thompson, & Whelan, 2016). However, following the legal rules, if the patient demonstrates total indifference, physicians may not perform medical interventions without notifying the patient’s legal guardian.
The problem with ethical assessment concerning continuing treatment without the patient’s consent is that people have different perceptions of morality. The literature on this issue is divided into two types of research: some authors believe that treatment should be based on the physiological and psychological aspects of the patient’s personality, while others talk about aggressive therapy (Crane, 2018). For this woman, it makes sense to talk about the degree of mental retardation. Adult patients with mild mental disabilities do not require “aggressive” treatment, but patients with severe mental disabilities require constant supervision by a psychiatrist with the involvement of caregivers and therapists.
This woman, with a profound form of mental retardation, should have a surrogate who makes decisions for her. Such a person is appointed by a court of law, or this person might be the legal guardian has chosen by the client. Surrogate undertakes to express the will of the patient and to provide the medical staff with all the necessary information. In addition, this person must decide the fate of the woman regarding her treatment. Except for the patient’s guardians and next of kin, the doctor may not disclose information about the patient with cancer. Notification of acquaintances and employees of the patient of everything related to the treatment process violates the law on medical confidentiality.
If, for some reason, the patient does not have a guardian, the decision to refuse the health care provider may make treatment. If an incompetent patient does not have a guardian, the clinic must determine the best way to not only meet the patient’s wishes but also provide a high level of care (Connor et al., 2016). In order to accept or reject a woman’s request, witnesses who were present at the time of admission should be interviewed to ensure that the physician was not biased against the patient. The final decision can be made using a variety of medical ethics tools.
According to the golden rule of ethics in medical terms, to decide whether to continue treatment without the consent of the patient, the doctor must present the following situation. If this doctor were in the patient’s position, he would probably only want treatment if it was effective (Tenery, 2016). Then the doctor should continue to treat the sick woman against her will if he is convinced that therapy will help her, rather than bring additional suffering. This is a rather complicated moral situation that does not exclude the elements of subjectivity. To meet these expectations, any doctor must have the necessary qualities. Among them are compassion, mercy, and duty as some of the most profound moral values of a doctor.
The answer to the request of the patient with breast carcinoma is on the border of treatment efficacy, self-respect, and consistency. Whether such a doctor has the right to refuse a patient’s request based only on his or her own beliefs is a dilemma. The physician’s answer must be balanced and cover possible questions about whether there are other solutions, how ineffective it is to refuse treatment, and what this can lead to (Gaitanidis et al., 2018). The prescribing physician must fully inform the patient and the caregiver of the stage of the illness, discuss possible pathways and outline his or her actions. Therefore, refusal of treatment may only be permissible if the patient or guardian has given informed and voluntary consent for medical care.
Refusal to treat a mentally disabled woman with breast cancer may be valid if the woman is in a state of legal capacity or has an official guardian. Refusal to intervene in a medical case is an inviolable right of any person, but the doctor and the clinic must certify the sanity of the patient. When a patient does not have a guardian, the decision is made by the attending physician in discussion with colleagues and loved ones with strict compliance with the laws of the state. The conclusion can be weighed against the use of moral tools: a golden rule of ethics combined with personal values. The decision should not be made unequivocally and without the patient’s opinion. If the author of this work were to be in the position of a decision-maker, a decision would be made to continue treatment after discussing possible ways and obtaining legal consent.
References
Bhattacharyya, S., Bhattacherjee, S., Mandal, T., & Das, D. K. (2017). Depression in cancer patients undergoing chemotherapy in a tertiary care hospital of North Bengal, India. Indian Journal of Public Health, 61(1), 14-18.
Connor, D. M., Elkin, G. D., Lee, K., Thompson, V., & Whelan, H. (2016). The unbefriended patient: An exercise in ethical clinical reasoning. Journal of General Internal Medicine, 31(1), 128-132.
Crane, D. (2018). The sanctity of social life: Physicians’ treatment of critically ill patients. London, England: Routledge.
Gaitanidis, A., Alevizakos, M., Tsalikidis, C., Tsaroucha, A., Simopoulos, C., & Pitiakoudis, M. (2018). Refusal of cancer-directed surgery by breast cancer patients: Risk factors and survival outcomes. Clinical Breast Cancer, 18(4), e469-e476.
Tenery, R. M. (2016). Medical ethics: medical etiquette. Journal of the American Medical Association, 315(12), 1291-1291.