A 48 year-old black women has developed stage III non-Hodgkin's lymphoma and needs combination chemotherapy for treatment. Without therapy she has no hope of survival beyond a few weeks or months. With therapy she has an 80% chance of complete remission. She understands this entirely, but insists that she simply does not want the therapy. There is no evidence of depression.
Which of the following is the most appropriate action?
- Honor the patient's wishes
- Ask the family for their opinion
- Offer radiotherapy instead
- Psychiatric evaluation
- Seek a court appointed guardian
- Risk management evaluation
But (A) does not make sense, given the information provided. The principle of autonomy does not allow a physician to lay aside his duty (rather, it binds him to respect the dignity of his patient as equal to his own). Choice (A) does not respect this patient; it betrays her.
The real answer is neither (A) nor (C). The real answer is: sit down with the patient; find out why she does not want this treatment. Her risk-to-benefit ratio is so low! What is she afraid of, or what does she believe about this treatment? And how can I help allay help her make the right choice?
Our Ethics class has operated from the very first lecture on the premise that there are no right answers. As a result, there is no "right choice" for a patient to make in a given situation. There is only the patient's desires and the doctor's opinion. In a world where there are no right answers, (A) makes sense. Ironic that I got the answer wrong in this world of relativism.
I'm contacting the course administrator about the question; we'll see what happens. (The grade does not matter, but the truth does.)