cancer patients autonomy and honesty

1Running head: The value of autonomy with cancer patients

The value of autonomy with cancer patients

Wadih Khnaizir

Lebanese American University

2The value of autonomy with cancer patients

Abstract

The importance of transparency with cancer patients is surely an essential

idea to discuss. The patient’s life and struggles was never discussed exhaustively

with complete detail even though it is the most important topic to discuss when

cancer is the main topic at hand. By referring to several databases, books, and

professional interviews with doctors and even with patients under treatment, I was

able to come up with information of great benefit. The importance of transparency

was discussed to show how it could affect on a psychological and on a professional

level too. The results obtained are vague and somewhat undecided since arguments

from different levels contradict and the information is missing to take a final decision

on how adjustments and amendments can be made to what has been previously

available. However, the conclusion came up to be that transparency is essential and a

priority in treating patients and to prove the latter, real-life examples were stated.



Outline

Claim: Doctors should be completely transparent with cancer patients in relation

to their cancer

I. Psychological

A- Transparency weakens the patient

1. Depression

2. Demotivation

B- Transparency supports the patient

1. Strengthens

2. Motivates

II. Professional

A- Should not abide by the AMA code

B- Should abide by the AMA code



Lost in a maze of imbalanced care, cancer patients struggle and face a lot of

encounters that affect them psychologically and might lead to significant gloominess

throughout the process of handling. This is why autonomy with cancer patients plays

an important role in helping the patient in a way that alleviates the barriers that the

patients have to cross and shapes a route of encouragement and precaution for the

patients to be guided with complete transparency away from any hidden information

or detail. This is why the matter at hand alarms doctors in particular and

demonstrates the importance of doctors being completely transparent with their

patients. A lot of disagreements exist on how the way transparency is handled can be

modified to suit everyone and help in a way where no harm is present and is all given

by related and concerned people on this specific topic. Arguments have been

ongoing on how transparency weakens the patient and how the oath doctors follow

can be adjusted to work better on such cases. Some professionally-related people

agreed and some disagreed and this is why the matter is a never ending dilemma to

be stressed on solving.

There has been a lot of controversy on the psychological level, some people

claim that transparency with patients leads to depression. Cancer is a chronic illness

that causes continuous suffering to patients and their relatives. The pain to the patient

can be social psychological or physical. The decision to disclose all the information

about the patient to them has been a controversial issue. Some people argue that

disclosing all the facts to the patients is beneficial while others disagree.


Psychological effects are the greatest form of suffering to a cancer patient. One form

of psychological suffering that cancer patients undergo is depression. Disclosing

their prognosis to them is one cause of depression to cancer patients. This is because

not all medical doctors will accurately determine the prognosis of the cancer patients

and provide the patients with accurate information (Baumgarten, 1997, p.74). By

hearing some of the prognostic statements, many cancer patients become uncertain

of the future, and they are attacked by depression and nervousness. The idea of

restricting freedom and checking out over cancer patients should not be avoided. Due

to their psychological sickness, it is important to restrict their freedom to some

degree, which is therapeutic. This is because if the scientific and the ethical basis of

patient autonomy are followed to the letter, the outcome is likely to be a

psychologically weak patient. The dignity of individuals is not degraded by

restricting freedom since the doctor has the responsibility to prescribe care that will

lead to the well being of the patient. A patient who is undergoing depression is

undergoing a main stage in the disease process, especially when they get their news

about the cancer disease which is sometimes a shock since the patients had no idea

about their case. The patients in this stage are psychologically disturbed because they

want to search for the most suitable solution to their problem. From the doctors’

perspective, this is like a normal stage in the process of the disease and is likely to

pass with time (Baumgarten, 1997 p. 89). During this stage, interventions need to be

implemented to terminate or reduce depression in these patients. The best

intervention that the doctors can give to the patient is providing therapeutic

encouragement and good news. Social interactions and communication to the patient


are of vital importance. They play a role making the patient feel important and thus

avoid the depression. Other than depression, there has also been a lot of controversy

concerning the demotivation that lack of transparency leads to. A period of

demotivation may occur due to the nature of cancer disease. This may be caused by

treatment failure. Many cancers are hard to treat, or they may not respond to

treatment at all. The probability of treatment failure is thus very high. In many cases,

the treatment failure does occur. When it occurs, the doctor does not lose hope but

continues with treatment. This is because the doctor has taken an oath to continue

ever being hopeful that a patient will get well. On the other hand, the client loses

hope with the treatment and the doctor. The relationship between the client and the

doctor worsens. This causes the condition of depression on the client to deteriorate

(Pellegrino, 2012 p.15). At the stage of deteriorated depression, demotivation is at

the peak. This is because depression and motivation go hand in hand (Pellegrino,

2012 p.28). The main goal of the doctor at this stage is to address the two main

problems of demotivation and depression to know what the problem at hand really is.

The difficulty the doctor encounters is the attachment of the two and their tendency

to go together. Nevertheless, the doctor does not lose hope with the client. Another

way of strengthening a cancer patient who has such kind of suffering is by divulging

all the information to them. Giving information to patients about their condition is

therapeutic in nature. The advantage of transparency is that it enables the patient to

know everything they should know about their disease condition. It is the right of a

patient to know the information about their disease condition. Getting the

information about their disease will help patients to make decisions about their


future, in relation to their disease. The patient is strengthened psychologically by this

form of honesty and will definitely be stimulated to resume with the treatment and

move on. (Gross, 2005 p.791). At the same time, giving information to clients helps

them relieve stress and calm the mind. The relationship between the patient and the

doctor is likely to be restored due to the honesty of the doctor. By discovering that

the doctor is honest, the patient is likely to renovate their hope in the doctor and to

complete treatment (Jens, 2002 p.253). This revives the strained relationship that had

deteriorated between the doctor and the patient. The doctor has made an achievement

for not losing hope. At the same time, the doctor is now in a good position to

encourage the patient to complete their treatment. A task that presents itself to the

doctor at this point is ensuring the patient completes the treatment and that the

patient will have a productive life after the treatment. For the doctor to achieve this,

they have to instill determination and hope to the client by being transparent.

On the professional level, the disputes were many and were all related to the

oath all doctors are obliged to take. Doctors in their treatment of cancer patients face

a dilemma because of the oath they took to abide by the ethical code of conduct.

Although they took this oath, doctors still are supposed to practice by application of

reasoning and common sense (Varelius, 2006 para.8). They cannot succeed in the

administration of care if they will not exercise common sense and reason. For them

to help patients and realize positive results, they have to exercise independence and

personal decisions. By doing this, they will realize the best outcomes for their

patients and they would be offering the elite treatment undoubtedly. The technicality

of the oath places many doctors under difficult circumstances in their practice. This


is because once it has been taken; an oath should be taken to the letter. Adhering to

this rule is difficult in some instances. This makes many doctors campaign for

changes and review of the oath. These doctors see the oath as a barrier restricting

them from using their vast knowledge in devising various ways of benefiting the

patient (Varelius, 2006 para. 12). Their argument is that changing the oath to allow

them to think independently without restrictions will have far reaching benefits to

them, their patients and the relatives. The result will be a healthy nation. Another

view about the aspect of an oath concerns the obligation of the doctor to provide all

the information to the patient without any imprecision. This view obliterates that

doctors have an obligation and the responsibility to inform the patients on their

condition on a time-to-time basis. Thus, physicians should practice it even if the

change of the condition is insignificant. The importance of this is to give the patients

the information required so that they can be better placed to make a good decision

about their health status. The patients have the right to decide by their own, and to

self-determine their own treatment (Vareluis, 2006 para.12). If they wish, they can

exercise their right to refuse treatment. The aspects of the practice of professional

standards have to be put into consideration by the doctors in the care of patients with

cancer. The doctor has to adhere to the professional code of conduct as outlined in

the code of conduct they signed, and as provided in the oath they took. The doctor,

therefore, has to be dedicated to offering enough time and honesty to the patient they

are caring for (Loewy, 2007 p.3). Observance of the law too is an obligation of the

doctor. In the event of controversial issues, the doctor should explore the available

solution so that the case can be solved expediently. The reason that an oath guides a


big number of people is the determinant of the terms and conditions as well as the

contents of the oath. The oath should fulfil the condition of being believed by the

majority of the people who take it (Loewy, 2007 p. 5-8). For example, doctors

should believe that the oath they take is the best for them. It is, therefore, liable for

acceptance by all the doctors. Although it satisfies many of them, this does not

eliminate the possibility of complications that may be brought about by the oath.

After taking the oath, dilemmas may still be there. The oath doesn’t completely solve

the problems some doctors believe should be resolved by adjusting and amending the

oath. The observance of medical ethics and transparency are of vital importance in

the profession of medicine, in particular, and health in general. This is because

medicine deals with the very sensitive part of human beings; their body which is the

base of a person’s life. The ethical code of conduct outlined in the professional code

must be followed to the letter with thorough meticulousness and mistakes are

definitely not an option. Transparency to the patient too should be given a priority

since a patient should be aware of the complete process and everything that is

happening to him/her. The doctors who believe that the rules should be changed are

out of the law and work independently in a way they believe is the appropriate way

and that all doctors should follow without any hesitation. Failure to observe ethics

can lead to immense disadvantages to the patient or to the doctor, or to both. For

example, if a doctor agrees to treat a child without the parents’ approval, the doctor

is putting himself or herself in risk. In the event that the condition of the child

deteriorates and maybe the doctor loses the patient, the doctor has to bear

responsibility for the life lost. The doctor may serve a life sentence because of their


decision to try to save a life. This exemplifies why doctors should be very careful

with observance of medical ethics (Terdin, 2009 p.16). In addition, it shows how

essential precision and perfectionism are for a doctor and that the work they do

should never be taken for granted because it determines the lives of people suffering

from several difficulties that has been discussed.

The decisions doctors take concerning treating their patients might be

agonizing and this is why we conclude that the importance of transparency and the

doctor-patient relationship is highly important and assists the patient to reduce all

forms of depression and stress that might result from hiding or delaying the

information a patient should definitely know about his/her cancer. Thus, prioritizing

transparency is an obligation after a professional doctor has given an oath to respect

such a requirement and after being a true doctor willing to help as much as possible

to advance and reach a stage where a patient is treated just like a family member

with the full care and precaution obtainable.


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cancer patients autonomy and honesty

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