NOTE: I chose to place this article under Ethics because I believe, as this article illustrates, that modern medicine is ethically violating their oath to cause no harm with their choices in treatment of many at the end of life. ~Greg Schneider, Founder & President, HVA
Click here to link to the full article:
The Independent SUNDAY 30 NOVEMBER 2014
This is an excerpt of various parts from the full article that illustrate the problem.
...There is no doubt that standard treatment for cancers, such as chemo and radiotherapy, can effectively cure many cancers – for example, early-stage bowel cancer, or testicular cancer. But in other situations where cancer has spread, the benefits of medicine are less certain. A study published in The New England Journal of Medicine in 2012 found that 69 per cent of patients with lung cancer and 81 per cent of people with bowel cancer did not understand that the palliative chemotherapy they were having was not going to be able to cure their cancer.
Palliative chemotherapy can indeed extend lifespans. However, a systematic review of the evidence for chemotherapy in one type of lung cancer – non-small cell lung cancer – published in 2008 found that it increased the survival rate from 20 per cent at one year to 29 per cent. Clearly, that's an improvement – but an improvement for only 9 per cent of the patients taking the chemotherapy. When we consider what's called the "treatment burden" – not just the visits to the hospital, but the side effects of fatigue, nausea, hair loss or nerve pain – many people will weigh up the chance of success, and, entirely reasonably, opt not to have it. It can be entirely rational to prioritize quality of life over quantity.
Yet the way we talk about cancer and illness can make people think that they have to have treatment – no matter the cost. Take a recent campaign in Glasgow run by the local Beatson cancer clinic. The massive billboard posters proclaimed: "Be full of hope. Be courageous. Be ready to fight." Similarly, Cancer Research UK want to raise money to "beat cancer sooner" and wants to "inspire others to join the fight". In 1977, Susan Sontag wrote, in Illness as Metaphor: "Illness is interpreted as, basically, a psychological event, and people are encouraged to believe that they get sick because they (unconsciously) want to, and that they can cure themselves by the mobilization of will; that they can choose not to die of the disease."
We see this all the time: obituaries that say that someone "lost his fight" against cancer. But there is a backlash. Recently, in the London Review of Books, Jenni Diski, who is being treated for cancer, wrote: "Under no circumstances is anyone to say that I lost a battle with cancer. Or that I bore it bravely. I am not fighting, losing, winning or bearing." The language used around cancer can make it seem as though only "fighters" deserve to "win", placing a moral judgement on people's choices about what treatments to have. This only makes it harder for people to stop or decline therapies – even when they are unlikely to help, generating only side effects that make quality of life poorer.
We know that most people would prefer to die at home. An audit published by the Royal College of Physicians this year found that, 87 per cent of the time, doctors realized that patients in hospital were dying, but in only 46 per cent of cases, it was recorded as having been discussed with the patient. So how can we get to go home to die if we don't know that we are in our last days?
A systematic review published in the BMJ in 2003 found that doctors tend to consistently overestimate how long they expect patients who are terminally ill to live.
A John Hopkins Precursor Study examined what choices American doctors made about death. While only about 20 per cent of the US population had made an advance directive, 64 per of doctors had. They were asked what kind of treatment they wanted if they had a serious brain injury. The vast majority wanted pain relief but not cardiopulmonary resuscitation, (CPR) dialysis, or intravenous fluids.
Far from wanting more aggressive medicine – they wanted less. It's tempting to conclude that the more we know about how ineffective many treatments are, the less we want them. Meanwhile, there have been concerns that the reason palliative care seems to prolong life in people with metastatic cancer is because patients get less aggressive medical care – which can lead to complications such as immune suppression and end up doing more harm than good. As for CPR, while medical television dramas frequently overestimate the likelihood of it working, the truth is that when CPR is used in frail people with metastatic cancer, it almost never works. Instead, it changes the nature of death. The peace of the deathbed is exchanged for the chest compressions, cracked ribs and electrical shocks of CPR.
Replies
The whole idea of "winning" a fight against cancer concerned me when I was invited to speak to the Gilda's Club Metro-Detroit Women of Color Cancer Support Group. One of the members had invited me to come speak about hospice, and I wasn't sure how other members would receive this because of the strong focus on being a cancer survivor. Sitting in a comfortable circle in the house where Gilda’s Club is located, I enjoyed an enthusiastic discussion with a group of women in various stages of cancer or remission. They shared highlights of their lives related to cancer and offered helpful reassurance to one another when needed. They seemed glad to have their hospice and other end-of-life questions addressed and discussed. A good "fighter" needs to be aware of all options available.