Breast Cancer is a serious issue that affects almost every woman worldwide, either directly as someone diagnosed with cancer, or indirectly through the illness of a loved one (Women’s Health Resource, 2014). Breast Cancer is found in women, in their twenties and thirties, and those with a family history of the disease. In 2006, approximately 212,920 new cases of invasive breast cancer were diagnosed in the United States alone (Women’s Health Resource, 2014). The case scenario will discuss the ethical and legal issues regarding a 25 year old female patient stricken with breast cancer, who refuses treatment for the disease, in addition to the four (4) ethical principles, (a) autonomy (respect for persons), (b) justice, (c) beneficence, and (d) non-maleficence.
A 25 year old female patient made an appointment with her primary care physician because she discovered a lump in her breast after a routine check. On the day of the appointment, the physician examined her breast, and made a referral for her to visit and oncologist, who specializes in the diagnoses and treatment of cancer. There are three types of oncologists. They are (a) medical oncologist (uses medicine (chemotherapy) to treat cancer), (b) radiation oncologist (uses radiation to treat cancer), and (c) surgical oncologist (treats cancer with surgery) (The Denise Roberts Breast Cancer Foundation, 2009). The patient schedules an appointment with the oncologist, who then will inform her of the diagnoses and treatments if needed as per the result of the biopsy. The result of the biopsy will confirm if the patient has breast cancer or not. Autonomy (respect for persons) acknowledges a person’s right to make choices, to hold views, and to take actions based on personal values and beliefs (Chowning et al., 2007).
To refuse treatment, the patient must be legally and mentally capable, and 18 years or older. Parents with children under the age of 18, have the right to consent or refuse treatment for his or her child. Physicians also have a moral and legal obligation to comply with a patient’s voluntary, informed refusal of life sustaining treatment, regardless of a physician’s judgment concerning the medical or moral appropriateness of this (Miller et al., 2000). A 25 year old patient with breast cancer refused medical treatment as suggested by the oncologist. Conflicts may arise with the patient as she made a decision to not receive care, which can ultimately lead to death.
Death may be seen as a failure, rather than an important part of life (Smith, 2000). Upon receiving the patient choice to deny treatment, the oncologist is then obligated to inform, and educate the patient about the benefits of treatment, and risks associated with not receiving treatment. The patient has the right to deny treatment, even when the physician suggests the benefits of treatment. The following treatment options are available to the patient such as, lumpectomy, mastectomy, chemotherapy, radiation therapy and eventually, surgical reconstruction (Woman’s Health Resource, 2014).
When a patient refuses treatment to care for the disease, autonomy then becomes a bit challenging. While there may be opposing views in regard to treatment or non-treatment, medical professionals must respect the patient decision, and support the patient during this process, while delivering quality care (Stringer, 2009). The rules of law are based on ethical beliefs that are commonly held in our society. These basic ethical principles include respect for individual autonomy, beneficence (helping others), non-maleficence (not harming others), and justice or fairness. Regardless of whether these ethical duties are derived from religious faith, natural law, or a social contract, these principles form the basis for the legal rules of our society (Harris, 2007).
The principle of beneficence means that the health care provider must promote the wellbeing of patients and avoid harming them (Rosenthal, 2006). When a patient refuses treatment(s), the health care professional must communicate the risks of not receiving treatment. The job of the health care professional is to provide quality of care to the patient, even when a patient refuses treatment. The health care professional must remain compassionate, as the patient expects the medical professional to still treat him or her with dignity and respect.
Non Maleficence means to do no harm. Health care professionals must always strive to do their work without malice or the intention thereof to the patient (Ask.com, 2014). The health care provider is obligated to aid the patient to the best of his or her ability by providing benefits, protecting the patients’ interest, and improve wellbeing. To ensure that the patient is not harmed while refusing treatment, the health care professional can conduct a risk benefit analysis where research on the disease and various medications can be found. Upon his or her findings, the health care professional should explain the effects of treatment or non-treatment. Under non maleficence, there is a legal “duty to warn” third parties, which is a critical and legal concept (Rosenthal, 2006).
The principle of justice means to treat others equitably, distribute benefits or burdens fairly (Chowning et al., 2007). Health care professionals must provide patients with treatment alternatives, and not misinform the patient about any of the medical processes involved. The major issue with this principle is that economic barriers can interfere with access to appropriate therapies and medications (Rosenthal, 2006). The health care organization is required to provide services or care to a patient regardless of health care coverage. Patients should also be treated equally regardless of age, race, or ethnicity. Patients must be treated with dignity and respect, even though he or she may refuse care or treatment for their medical condition.
One of the most common place ethical dilemmas in the health care industry is a patient refusing treatment to care, as this action may threaten his or her wellbeing or health. The health care professional must determine what aspects of autonomy, beneficence, justice, and non-maleficence need to be used before providing care. A physician has the legal right to ensure and provide the patient with sufficient information about treatment plans, and care. Health care administrators must examine underlying issues such as competence of the patient, the distinction apparent, and refusal of care (Michels, 1981). In the case of the 25 year old patient, ethical issues were present because her right to refuse treatment conflicted with the oncologist’s obligations to provide quality care to her.
Ask.com (2014). What Is Non Maleficence? Retrieved from http://www.ask.com/question/what-is-non-maleficence Chowning et al. (2007). An Ethics Primer. Seattle WA: Northwest Association of Biomedical Research. Retrieved from https://www.nwabr.org/sites/default/files/NWABR_EthicsPrimer7.13.pdf Harris (2007). Contemporary Issues in Healthcare Law and Ethics, 3e. Retrieved from University of Phoenix Michels, R. (1981). The Right to Refuse Treatment: Ethical Issues. American Psychiatric Association, 32(1), 251-255. Miller, F., Fins, J., & Snyder, L. (2000). Assisted suicide compared with refusal of treatment: a valid distinction? Annals of Internal Medicine, 132(6), 470-475. Rosenthal, M. S. (2006). Patient misconceptions and ethical challenges in radioactive iodine scanning and therapy*. Journal of Nuclear Medicine Technology, 34(3), 143-50; quiz 151-2. Retrieved from http://search.proquest.com/docview/218613783?accountid=458 Smith, R. (2000). A good death: an important aim for health services and for us all. British Medical Journal, 320(7228), 129-130. Stringer, S. (2009). Ethical issues involved in patient refusal of life-saving treatment. Cancer Nursing Practice, 8(3), 30-33. The Denise Roberts Breast Cancer Foundation (2009). Breast Health. Retrieved from http://www.tdrbcf.org/oncologist/index.html Women’s Health Resource (2014). Breast Cancer. Retrieved from http://www.wdxcyber.com/breast_home.html
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