A 60 year-old widow was referred to me because she has Stage IV Lung cancer. Upon seeing her, she looked very very ill. After evaluating her, I knew that the reason why she seemed very ill is because she is in a lot of pain.
The initial plan then was to minimize the pain and make sure that she was comfortable. I immediately put her on opioid analgesics and the following day, she had an entirely different and more joyful aura.
At this point, when the patient was already comfortable, I started discussing with her about her condition. She had an advanced form of cancer which was unlikely to be cured. However, there are medicines, mostly in the form of chemotherapy, that may prolong a patient’s survival and not all these medicines are as toxic as we know chemotherapy to be.
I explained to her the disease, its extent, what can be expected with and without treatment, the possible side effects of treatment, the benefits as well as the financial cost of the treatment. The patient was lucid, fully conscious and stated that she understood what we have discussed and requested to be given time to think about it.
A week later, the patient’s children informed me that after thorough discussion with the entire family, the patient decided that she did not want to undergo chemotherapy but only continue with pain control.
Her children were a bit in distress over the patient’s decision because they wanted the patient to undergo treatment.
The patient’s decision was final yet the family did not feel comfortable about the patient not pursuing active treatment for the tumor. There were streaks of guilt in their hearts thinking that not giving active treatment is like hastening the patient’s demise.
These concerns are very common among patients and relatives and have always been a source of distress.
What Can We Do?
These concerns are quite understandable and normal. All of us want to do everything we can to prolong the life of someone we love. I have encountered families who are willing to sell all their properties to finance treatment.
But what if the patient has a will of her own?
The solution here is very simple yet both painful and difficult. We can explain, rationalize, cajole, plead, convince or go to court to revert this decision but at the end of the day, as long as the patient is of sound mind, has understood the situation as well as the options and is capable of giving a decision, there is nothing more we can do but to follow and respect that decision.