October 16, 2009
1 min read
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Isn't it the patient's right to refuse treatment?

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I thought it was generally accepted that adult patients have the right to refuse treatments, including chemotherapy, presuming they understand the benefits and risks of the proposed treatment and what their disease is likely to do without treatment. Apparently not every oncologist agrees with this.

This week in The New York Times, the Well Blog published a story of an oncology fellow who refused to allow a patient to decline the proposed treatment plan. The article does not tell us the patient's diagnosis but does state the patient's treatment plan would require a month in the hospital, a central line and chemotherapy, so I am assuming this may be acute leukemia? This is important, and I presume that this patient has a very treatable form of cancer, because if it is an incurable cancer, and chemo will prolong life but not cure, this doctor's obstinancy would be even more ridiculous.

In any case, once the patient refused the chemotherapy and wanted to go home to enjoy whatever time he had left, the treating team listed him as AMA — against medical advice — for his discharge and declined to refer him to hospice on discharge.

Think about this for a minute. You have leukemia, you don't want the treatment I propose and now I am going to make you go home to die on your own without the hospice benefit which is your right (at least for nearly all patients with private insurance, Medicare or Medicaid). For me, this is equivalent to telling the patient you want him to suffer in death for the choice he made regarding his cancer treatment. This oncologist should be ashamed.