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
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.