Limits to Life-Sustaining Treatment

3. Earlier stage of terminal illness

The patient has fought the cancer for months and years by every means available - surgery, radiation, immunotherapy, chemotherapy - including experimental drugs. Nothing has stopped the spread of the cancer which now has metastasized to bone and brain. She is in excruciating pain which cannot be dulled by safe doses of pain medicine. The Oncologist says that she may have a few weeks to live - perhaps a month or two, but not more than that.

The Oncologist mentions that there is a new experimental drug that has just become available which has never before been used on a human being but showed some promise in animal tests by shrinking tumors of the sort this patient has. She says "I have suffered enough. I do not want to suffer the nausea and other side effects of another experimental drug in my last weeks." Then she turns to you and says, "If you think I really SHOULD try the new drug, I will do so."

Would you advise her to try the drug?

What if she asked for doses of pain medicine that might compromise her respiration? Would you consider giving them to her?

There is a good deal more at stake here than in the terminal stage of illness - more chance of a remission (although the odds of a complete remission are still so slim that it would be considered a miracle); and there is certainly more chance that moments of value to herself and others would be lost if she died sooner rather than later - a few more conversations with family, a few more gentle touches by nurses, etc.

Created by Glenn C. Graber
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