Why Would Someone Refuse Treatment?
The reasons for opting out of cancer treatment are as diverse as the treatment options themselves. For some women, it's purely a personal decision; for others, cultural or religious considerations may play a part. Here are a few of the reasons why a patient might not be eager to begin treatment:
The need for more time before commencing treatment. In deciding against an immediate start of therapy, a woman may not be ruling out treatment altogether. She may be leery of jumping into a treatment plan while she's still coming to terms with the diagnosis. Or she may want to delay treatment for a wedding, big trip or some other specific event.
Skepticism about health care. Patients who have witnessed bad outcomes -- or are generally distrustful of the healthcare system -- may not be willing to put their faith in a treatment plan or medical team.
Fear of the side effects of treatment. The side effects of breast cancer treatment can be difficult and may have a profound impact on a woman's quality of life. Depending on what stage of life she is in (and the stage of her cancer), she may decide that the likely benefits don't outweigh the hair loss, nausea, missed work and other effects.
Matters of faith. Many religions discourage certain medical interventions that may be necessary for cancer treatment. Even in cases in which the patient's religion doesn't explicitly forbid treatment, she may feel comforted by entrusting her fate to a higher power.
A desire to maintain quality of life in the time remaining. If a woman's prognosis isn't good, she may prefer to spend her days doing what she loves rather than fighting a battle she's unlikely to win. Likewise, for advanced cancer cases, some women choose hospice care, with its emphasis on emotional support, maintaining quality of life and pain control rather than aggressive interventions or participation in clinical trials to test new therapies.
How Can This Be Allowed?
While it may be hard for those around to understand a woman's decision to refuse cancer treatment, this option is well within her rights. Her physicians may urge her to reconsider, especially if her chances for recovery are good. But in the end, they must defer to her wishes.
As part of the decision process to undergo or decline significant medical treatment, patients must either give or withhold their informed consent. Most people have encountered one aspect of informed consent, which is the signing of a medical consent form.
But informed consent is much more than just signing a document. It involves discussing the risks and potential benefits of the recommended treatment, as well as the risks and benefits of receiving no treatment at all. The physician addresses the patient's questions about treatment.
The decision does not need to be made immediately. Patients may want to discuss their options with loved ones or think about them privately before making a decision. Patients may have follow-up questions or they may want to consult another clinician for a second opinion before making a final decision.
Whether a patient decides to accept or decline treatment, she may be asked to sign an informed consent document confirming her decision.
What Alternatives Are There?
Although some patients who refuse treatment may simply return to their lives prior to diagnosis, others seek out healing in other directions. Rather that trusting in conventional medical therapies -- such as surgery, chemotherapy and radiation treatment -- some patients turn to complementary and alternative medical (CAM) treatments that lie outside the realm of conventional therapies, or serve as alternatives or complements to them. Examples of these include:
None of these are as well-researched or empirically grounded as conventional treatments. Also, they may not be covered by health insurance plans. But they can be a source of strength and comfort to someone living with cancer.
Before beginning a CAM treatment program, patients should ask the same sort of questions they would ask in regard to conventional treatments:
- What benefits can I expect?
- What risks are involved?
- What side effects might I have?
- Is this therapy typically covered by a health insurance plan?
If someone you care about has chosen not to continue their cancer treatment, be as supportive as you can. She may have already been met with resistance from her healthcare provider and those closest to her. If her mind is made up, she won't welcome yet another debate.
If she's still struggling with her decision, offer to listen and help her sort through the options. Ask if she'd like you to join her for support at her next doctor's appointment to help her get the answers she needs or stand her ground.
Sources:American Cancer Society Staff, "Informed Consent." Cancer.org. 2 Mar. 2007. American Cancer Society. 23 Apr. 2008 .
Huijer, M. "Personal Values and Cancer Treatment Refusal." Journal of Medical Ethics 26(2000): 358-362. (subscription)
National Cancer Institute Staff, "Complementary and Alternative Medicine in Cancer Treatment: Questions and Answers." National Cancer Institute Fact Sheet.. 17 Jan. 2006. National Cancer Institute. 23 Apr. 2008.
Sharf, B. "A Little Bitty Spot and I'm a Big Man: Patients' Perspectives on Refusing Diagnosis or Treatment for Lung Cancer." Psycho-Oncology 14(2005): 636-646. (subscription)