When does treatment become a life sentence?
Submitted by Michelle Terwilliger, BSN, MSCN,RN
As healthcare providers, treatment should be considered as helping our patients. This is true many of times. Although, there are some situations in healthcare where too much care can seem overwhelming or imposing on one’s dignity. Such patients are those with a terminal diagnosis as cancer patients. Patients, for the most part, feel the need to adhere to a doctor or nurse practitioner’s treatment order. These patients may feel if they do not adhere to the plan of care their doctor or caregiver may not understand their reasons for not following orders. Typically, these patients will continue with their treatments despite their desire or pain status. Cancer patients at times go through chemotherapy and radiation together. This can be very taxing on a patient and often times cause the patient to become sick and weak. The question then arises, when, as healthcare providers are we pushing our patients past the point where they are losing their quality and dignity of life? Are we as healthcare providers not able to say no to our patients and inform them so they can make the decision on their own that this treatment is too much?
Medical advancements provide patients with the ability to live a longer life, but what is the price to pay for these advancements (Gennip, I., Roeline, H., Pasman, W., Oosterveld-Vlug, M., Willems, D.,& Onwuteaka-Philipsen, 2013)? Dignity is defined as “the quality of one’s life, based on rational decisions, can be measured only by the individual’s own value system” (Breier-Mackie, 2001, p. 518). Does longevity mean more than quality and integrity? As a health care provider we have witness patients come for radiation treatment and can barely walk. Sometime they may need to hear it is all right to take a break. Your body may need a little rest. As healthcare providers we can continue to treat patients with a holistic approach, promote patient autonomy, and not just a number on a graph to show who is a survivor on a statistical chart. “Patient-centered care is driven in part by the ethical principle of autonomy and considers patient’ cultural traditions, personal preferences, values, family situations, and lifestyles” (Sine, D., & Sharpe, V. (2011), p.32). These ethical principles should all be involved with every treatment for every individual.
Health care providers honor a code of ethics in which as professionals one should follow. As to the extreme one takes these values and decides to advocate for the patient is at one’s own discretion. This writer was trying to convey at times a patient may need to hear both sides of the treatment plan (story) and advise them of their options whether good or bad. As nurses one’s job is the advocate, after-all nurses spend the majority of the time with the patients and have developed a form of relationship. This may seem somewhat of a burden on a doctor as one may feel the nurse is attempting to sway the person to not receive treatment, when in fact one is just being an advocate for a person and someone the patient can confide in.
Financials never seem to go without notice when going to the hospital. Patients are likely worried about the excess bills and cost of treatments. These patients who are swaying back and forth whether this is the right treatment or they want to stop but are scared to say can save the healthcare industry money and themselves. Chemotherapy, radiation therapy, CAT scans, MRI, PET scans, and the cost of expensive test, treatments, and medicine can quickly add up. This can save the patient and hospital thousands of dollars to say the least. Some of this can be dropped if as professionals one can listen to the patient and follow their wishes. Unfortunately, as a professional nurse for eighteen years this story is all so real and seen so many times.
As any part of the healthcare providing system one has a right to stand up for their patient and let them know sometimes no care may be the best care. Perhaps educating the patient a little more on their choices can make them want to participate and feel like individuals. They are than treated with dignity and respect not just another number or statistic. Patients may reply with a simple “thank you I needed to hear that”. This writer has taken care and lived with a cancer patient and has witness the day-to-day suffering. Looked hope straight on and prayed her pain would go away. She, my mother-in-law, had stage IV small cell lung cancer. She was treated with both chemotherapy and radiation. She grew weaker and weaker each day. She was unable to eat, hardly walk, and she was just a shell of a person that once was. She was told she could be cured. Six months later the cancer spread everywhere liver, lungs, and bone. They wanted to do chemotherapy, radiation and whole brain radiation this time. The point of this is where does it stop? How much does one need to go through? Obviously it should be at the patient’s discretion. This writer just wanted to remind those healthcare providers sometimes there needs to be an angel on their side letting them know they will be ok. Life is bitter sweet and even though there are advances in medicine even the best medicine cannot cure but prolong dying and at what cost and quality of life are you able to take from someone?8
Breier-Makie, S., (2001). Patient autonomy and medical paternity: Can nurses help doctors listen to patients? Nursing Ethics 8(6), 510-521.
Gennip, I., Roeline, H., Pasman, W., Oosterveld-Vlug, M., Willems, D., & Onwuteaka-Philipsen, (2012). The development of a model of dignity in illness based on qualitative interviews with seriously ill patients. International Journal of Nursing 50(1), 1080-1089. Retrieved from http://dxdoi.org/10.1016/j.ijnurstu.2012.12.014
Sine, D., & Sharp, V., (2011), Ethics, risk, and patient-centered care: How collaboration between clinical ethicists and risk management leads to respectful patient care. Journal of Healthcare Risk Management, 31(1),.32-37. doi: 10.1002/jhrm.20077