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Ethical Issues In Advanced Patient Care

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The word “cancer” for many physicians who have lost a patient to the various presentations of the disease conjures feelings of hopelessness, especially in cases of advanced cancer. Despite the enormous advances in technology over the past century, medicine has not been fully able to counteract the devastating effects cancer has had on an individual’s physical ability to cope and mental ability to hope. In the field of oncology, where death is a grim reality to physicians treating patients, the concept of “hope” can be a powerful entity to promote. In the article, “Prognostic Communication With Advanced Cancer Patients,” the author main argument is that it is ethically justifiable to present the prognosis to gravely ill cancer patients in such a way that “allows the cold, hard facts to come out over time [strategically delayed], as opposed to presenting them up front” which in turn would preserve a glimpse of hope for the patient (1). The author terms this type of communication as “necessary collusion” with the patient in order to delay or slowly reveal the numerical prognosis of the cancer. Three specific assertions are mentioned by the author to support his argument: 1) the collusion is what the patients’ truly want, 2) it preserves some sort of hope by acknowledging the uncertainty of the disease outcome, and 3) further preserving hope by allowing the details of the prognosis to emerge over time (1).

In examining the author’s first assertion in stating that necessary collusion is consistent with patients’ wishes, the author cites various studies which conclude that although patients want a clear prognosis for their cancer, most do not want a quantitative estimate of survival. The author supports his second assertion stating “it seems wiser to avoid devastating (and often inaccurate) time frames until there are clear indications that a patient is ready to hear them” due in part to the variability (uncertainty) of the biological characteristics of cancer disease itself (1). Thirdly, the patient is seen as accepting the magnitude of the cancer progress better in time rather than at the beginning of initial diagnosis. Based on the author’s three main assertions, the argument is that hope can be preserved by delaying the complete reality of the cancer prognosis to the patient.

I think the idea of hope in advanced cancer patients is important, perhaps more so than any treatment in terms of the mental psyche of the individual. However, I do not agree with the methodology and assertions that the author uses to preserve a cancer patient’s hope. The doctrine of informed consent requires that patients “know the nature of the intervention, the expected benefits, the risks, and the likely consequences” (2). I believe that patients should be made aware of these components of informed consent at the initial diagnosis rather than waiting. Specifically, a numerical prognostic range of life expectancy should be discussed at the beginning with the patient in a way that informs the patient of the severity of the cancer. In this manner of disclosure, the patient would be afforded to make the appropriate steps to organize his or her life and come to terms in a sense with his or her loved ones. If we were to delay any aspect of delivering prognostic information to the patient, I believe the right to decide on alternatives to treatment and careful thought to end of life



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