Choices

Today, I saw a patient who has a potentially curable cancer.  They live far away and would have to travel a great distance for treatment, so we offered admission to our hostel.  We explained everything.  I spent about 20 minutes explaining that it was a big tumor with positive surgical margins, but that radiation would decrease the local recurrence riskto less than 10%.  And chemo would decrease recurrence systemically.  Good odds.

He was well.  Elderly, but well.

Yes, the treatment has side effects.  Significant ones that are still easily managed.

And he took in what we said.  His wife listened.  And at the end of our conversation, I asked him what he thought and he said, “no.”

I am a big proponent of people having autonomy, but I had to ask why.  He said he didn’t want to travel and stay here.  He wanted to be home with his wife.

We reiterated that after the 7 weeks of treatment, he can be home all the time.  He may have years.

He responded that he may not.

He is a competent person who can make his own decisions.  His wife agreed.  They had talked about it before.  No treatment after surgery.

They asked about time.  We don’t know.  The tumor was slow growing, but there was some left behind.

I agree with his decision.  I would take treatment if it were me, but it wasn’t me.  And people have choices.  And he made his choice.  I am glad he had the gumption and courage to actually say what he wanted instead of just going along with the doctors and being miserable.

It is funny, some people beg for treatment.  Treatments that will almost inevitably offer minimal benefit.  Treatments that cause pain and suffering and even hasten the death they are trying to avoid.  They clamour for any experimental drug.  And I get that.  We all have a drive to live.

But, then you contrast it with this couple.  A theoretical potential cure.  A definite, statistically significant increase in disease free survival and overall survival.  Turned down because the travel is unacceptable.  And it wouldn’t be quality of life.  This while so many trade their quality of life for brief periods of extra time.

Some might argue turning this type of treatment down is putting themselves at risk.  Suicide even.  But, really, it is the same as choosing to take antibiotics for an infection.  The infection might kill you, or it could just get better.

Socially, this guy is braver than the people who fight for the cure.  Societally we put a lot of emphasis on cure and avoiding death (not that his death is impending by any means).  People, however, see this as a loss.  He failed to take treatment.  The thing is, he made a choice because there are things in his life other than health.  He understands that.

People are fascinating.  I can’t say for sure what I would do in these situations.  But, sometimes I wonder why people choose the way they do.  And why some people expect so much and others so little.

I hope he enjoys his time with his wife, whether it is months or years.  I hope he never comes to regret his decision.

I respect autonomy.  Sometimes things like this make me sit back and think.  Especially when outcomes could be so very different with a different decision.

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2 thoughts on “Choices

  1. Wow. I don’t think I would make that kind of choice. It’s great of you to respect his autonomy – I would have to work really hard at not trying to change his mind. It makes me sad. Like you, I simply hope he does not regret his choice…

    • I still tried to change his choice or at least tease out reasoning a bit more initially because that kind of decision is not one that people go into lightly. It is a tough situation.

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