Ethical Dilemma: Refusal from Breast Cancer Treatment

The patient’s request to stop cancer treatment is a morally difficult issue from the point of a healthcare practitioner since it represents a specific ethical dilemma. The basis for the dilemma is a need to balance the principle of respect to patient’s autonomy and practitioner’s professional obligation to provide the best possible level of treatment and care. In the suggested scenario, the problem is aggravated by the fact that a 41-year-old woman, who asks for the termination of breast cancer treatment, has been developmentally delayed since birth. As a result, the medical practitioner responsible for the case has to identify the critical stakeholders involved and adequately evaluate the reasons for their decisions. Moreover, a skillful nurse or physician would find an effective alternative solution to solve the dilemma without violating the principles and moral obligations of the involved parties. Following the principle of the golden rule, the best solution for the evolved dilemma is to fulfill the patient’s request but insist on the need for performing radiation therapy or surgery instead. The benefit of the suggested solution is that it does not violate the patient’s autonomy and ensures that the healthcare provider does his or her best to avoid negative implications of this person’s decision.

Refusal from Breast Cancer Treatment Dilemma

The patient’s refusal from cancer treatment is a serious concern for the medical staff since every healthcare professional is aware of the medical risk of such a step. In particular, the patients who refuse breast cancer therapy have a lower five-year survival rate compared to individuals who accept treatment (Chen, Kung, Huang, Wang, & Tsai, 2015). Nevertheless, some patients insist that a physician or nurse should stop cancer treatment for an individual reason. On the one hand, a healthcare practitioner may accept such a decision, as he or she has to respect a patient’s right to autonomy and responsibility for any decision related to his or her health. However, the experts claim that although the need for respect of this principle is evident, it is associated with numerous ethical dilemmas (Murgic, Hébert, Sovic, & Pavlekovic, 2015). The patients have the freedom to make choices about their lives and medical treatment, but it has to be balanced with the paternalism of nurses and physicians who are aware of the negative implications of the patient’s decision (Murgic et al., 2015). Thus, a physician’s or nurse’s expertise and knowledge may be the source of paternalism, which definitely would violate the principle of respect to a patient’s autonomy. Moreover, the suggested case of treatment of a 41-year-old woman has an additional challenge, which is the woman’s developmentally delayed state since her birth. Being aware of this developmental issue, some practitioners may ignore her decisions, thus presuming that she is unable to understand the gravity of the outcomes of her request.

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The solution of the evolved ethical dilemma depends on the depth of the analysis of the factors associated with the case. Thus, the healthcare practitioner has to assess the woman’s ability to comprehend the reason for her request as well as its implications. For example, disregarding her developmental delay, the patient’s decision might be caused by her adverse emotional condition, such as exhaustion, depression, or a desire not to be a burden for her family and children (Carlson, 2014). Therefore, the first step in addressing the dilemma should be to “clear up misunderstandings” and define her wishes associated with treatment as well as with the evolved situation in general (Carlson, 2014, p 29). The second critical step is to assess the level of the patient’s understanding of the threat of breast cancer and the implications of the refusal from any care. In this respect, Carlson (2014) exemplifies that approximately 85% of patients who refuse from cancer treatment near the end of their lives have delirium and are unable to understand and process information. The final step toward solving the aforementioned dilemma is to analyze possible alternatives to cancer treatment, which would solve the problem without violating the principles that guide the key stakeholders.

Identification of Stakeholders

The two critical stakeholders involved in the dilemma are the patient and her physician. In such a situation, the patient has a right to freely decide the way she has to be treated. The indicated right represents one of the fundamental human rights involved in patient care since people may suffer from the lack of independence related to their treatment (Ezer & Overall, 2018). The second primary stakeholder, a physician, has professional obligations as well as individual ethical judgments that guide him or her in the professional career and daily activities. Moreover, the nurses and physicians have to follow the code of medical ethics, which influences their consent, communication, and decision-making. In this respect, the AMA Code of Medical Ethics (2018) states that even mentally impaired patients may still be able to participate in specific aspects of decision-making. Therefore, it is a professional obligation of a physician to evaluate the level of the patient’s understanding of the problem in general as well as the reasonability of her decision. Lastly, the patient’s family and administration of the medical facility represent secondary stakeholders, and their basic need is to ensure that the patient’s case is solved in the way that supports the appropriate level of her life and health.

Alternatives to Breast Cancer Treatment

Modern medicine offers different solutions that address breast cancer, such as radiation therapy and surgery. The benefit of these interventions is that they do not require long-term administration of different medical substances, especially in the case with chemotherapy. For example, the experts report that such types of surgery as mastectomy or lumpectomy reduce the risk of the evolvement of cancer and have extremely low complication rates (Macdonald, 2014). Moreover, in the case of performing mastectomy, which is a complete removal of the patient’s breasts, the reconstructive therapy allows to restore the desired size and shape of the breast (Macdonald, 2014). In the case of radiation therapy, the patient would not lose breast tissue since it addresses only cancer cells. Such a therapy is painless, invisible, and performed with high-energy x-rays, protons, or other particles that eliminate cancer cells (Mayo Clinic, 2018). At the same time, it has side effects, such as fatigue, skin irritation, breast swelling, changes in skin sensation, and increase of the risk of rib fracture, inflamed lung tissue, and secondary cancers (Mayo Clinic, 2018). In this way, the nurse or physician responsible for the patient’s treatment has to offer a model of treatment, which can be characterized as a safe and effective clinical approach.

Recommendation

In order to solve the abovementioned ethical dilemma, the healthcare practitioner has to evaluate the level of the patient’s understanding of the problem and offer such substitutes to cancer treatment as radiation therapy, lumpectomy, or mastectomy. The benefit of such a strategy is that it meets the interests of the involved stakeholders. In particular, a nurse or physician would meet the patient’s request to terminate standard cancer therapy. Apart from that, the healthcare practitioner would ensure that this woman is not left with her disease without any treatment option. The basis for the suggested recommendation is the principle of the golden rule according to which a healthcare practitioner has to perform the treatment in the way he or she would like to be treated.

Implementation

The implementation of the suggested solution is quite simple since it requires the performance of standard actions, such as interviewing the patient and assigning the type of therapy selected by her. At the same time, the role of the interview is critical, as it has the goal of assessing the patient’s level of understanding of the problem. Therefore, it is better for a nurse to use the assistance of a professional counselor who would assess the patient’s capability for making autonomous decisions.

Conclusion

All in all, refusal from breast cancer therapy is a typical problem in oncological units, and it should be effectively solved by offering alternative solutions to standard chemotherapy treatment. In the case of a 41-year-old female patient with a developmental delay who refuses from breast cancer treatment, the reasonable solution of the ethical dilemma is to assess her mental capabilities and propose a valid treatment substitute. In this way, the analysis of the case demonstrates that it is possible to solve the dilemma in the way that suits all the involved stakeholders since such approaches as breast radiation therapy or surgery effectively address the patient’s disease.