Ethics in End-Stage Cancer

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The advancements in the treatment of cancer have greatly increased the odds of survival; even for the worst types of cancer. Miraculous and inspirational recoveries, such as those by chief Justice William H. Rehnquist, who was recently hospitalized with complications from thyroid cancer, and cyclist Lance Armstrong, who overcame testicular cancer to win a seventh straight Tour de France, give hope to people across the globe that their loved ones may also share in the miracle and pull through. Unfortunately, even with the most aggressive and advanced treatments, cancer can continue unabated and progress to the end-stage.

Medicinenet.com defines end stage as, the last phase in the course of a progressive disease. The term "end stage" has come to replace "terminal" because somehow "end stage" seems more scientific and less despairing than "terminal." The only "stage" past "end stage" is usually death or a reprieve from it by a transplant (medicinenet.com). "everyone wants a miracle," says Dr. Smith, who works at the massey cancer center at virginia commonwealth university. "You have to be truthful," he says (healthology).

Sometimes the hardest fight is the fight for the proper treatment of the disease. What treatments must be used, for how long, when to stop, or when to change tactics are all questions that must be answered throughout cancer treatment. These questions become even more prevalent when the cancer enters the end-stage. No one wants to see the suffering that is often associated with end-stage cancer and hospitals and treatment facilities want to minimize the number of patients they lose from the disease. However, doctors and hospitals must use the most up to date research and knowledge to decide when treatment becomes unethical and further treatment becomes unnecessary and potentially harmful.

Importance to Nursing

Leading doctors, hospitals, and organizations differ greatly on when to cease treatment for end-stage cancer. on one hand continued treatment could possibly extend the patient's life long enough for the proper treatments or a breakthrough to become available, which may save the patient's life by sending the cancer into remission. on the other hand, continuing treatment may not only give false hope to a patient and their grieving family, but may also bring about undo pain and suffering as a side effect of treatments that ultimately prove ineffective or untimely. doctors, nurses and patients must work together to decide the optimal course of treatment and when to cease all treatments, save for pain relieving treatments, so that the patient and their families may enjoy their last days together.

Research shows that extending treatment is not always the best or most patient friendly protocol. a large review of medicare records showed in 1999 that nearly 12 percent of cancer patients died after receiving chemotherapy in the last two weeks of life. This was up from 1993 -- 10 percent -- and is probably higher today. these individuals could have been peacefully preparing for death and instead were suffering through the trials of harsh treatment (donaldson). According to a retrospective chart review presented at the multinational association of supportive care in cancer/international society of clinical oncology (mascc/isoo) meeting, chemotherapy should not be administered too close to end of life because it compromises quality of life in end-stage disease in cancer patients. Investigators found that less than half of the patients receiving chemotherapy went on to receive outpatient chemotherapy. "The fact that less than half went on to outpatient chemotherapy implies the majority of patients were approaching death," said Dr. Simmons. "the use of chemotherapy has important implications for quality of life and resource utilization" (Gagnon).

Each cancer presents itself differently and the resulting pain and complications will be unique to the individual patient, but each case involves one common factor, a human being who is most likely in extreme pain and discomfort. Treatment by the physician should take this important fact into consideration first, before deciding on a course of treatment. Little can be done to prolong the patient's life when end-stage cancer is reached. At this point, most patients and their families agree that any treatments with serious side effects are best avoided. Since death will result in a matter of days, weeks or months, treatment focuses on the cancer patient's comfort so that he or she can enjoy the end stage of life with as much dignity and little pain as possible (mesothelioma adviser).

Each of these research studies, and hundreds more like them, show that a doctor or hospital should first treat the patient and then treat the disease. Pain and suffering should be the main concern in treating end-stage cancer and making the patient as comfortable as possible to enjoy their remaining life, should be the number one objective. Doctors must have a willingness to accept that there is a time to stop, followed by an honest conversation with the patient whose cancer has spread widely and is incurable (Donaldson).

Conclusion

"Declare the past, diagnose the present, foretell the future; practice these acts. As for diseases, make a habit of two things-to help, or at least to do no harm". Hippocrates, the father of the hippocratic oath, felt that a doctor should always put the patient first in treatment. That has been true from the start of human medicine and nursing and remains the basis for medical care today. When treating end-stage cancer, or any debilitating and painful disease, treatment of pain and making a patient comfortable should be first priority. To properly treat end-stage cancer doctors, nurses and patients must work together to decide when the treatment should cease and when patients should be instructed that further treatment would show no benefits.

Cancer specialists report that overly aggressive treatment gives false hope and puts people though unnecessary suffering and costly ordeals when hospice would be a more effective route. The purpose of hospice is to help people die with dignity and in comfort. Frankness is what everyone aspires to, but one that seldom happens in practice, according to various studies. Research has shown that doctors overestimate survival by five times as much as what it turns out to be, and many avoid end-of-life discussions all together (healthology). Doctors, nurses and patients must learn to communicate treatments, expectations, and the possibility of the treatments ending in order for the treatment to be the most effective.

Ethics in End-Stage Cancer

Importance to Nursing

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