The "ethics of dying" of cancer - 1269343

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amd5
The "ethics of dying" of cancer - 1269343

I recently saw my oncologist and found out that six brain met's were discovered. To my surprise, he asked me have I ever considered the ethics of dying so that the insurance company and other people can save money.

I said I pay almost $6900 a year in monthly premiums and another $5000 a year to satisfy the insurance deductible. My answer is his ethics question was "NO." I've my premiums and should not be made to feel guilty about it.

If I were in rapidly declining heath and getting much older, he might have a point. In another two weeks, I'll be getting "gamma knife surgery" as well as additional chemo for my lung cancer.

What do the members of this forum think about this? I think my oncologist was weigh out of line to be giving me ethical advice on this matter. My brother and I agree that if I were to report this to the management at the hospital, I could get the onc. fired for his own breach of ethics. :twisted:

cards7up
I'd be surprised if my doctor

I'd be surprised if my doctor said that to me and I'd be looking for a new doctor. If you were on your dying bed, it might be appropriate to talk about hospice care, but not a comment like this. I think you have every right to be offended. I've never heard of such a thing.
Take care, Judy

dldl94
Just amazing. Time to find

Just amazing. Time to find another MD! And yes, feedback needs to be provided to medical staff adminstraion of hosp/clinic.

catdander
I'd like to know what the

I'd like to know what the policy is on that type suggestion from the oncologist's group, cancer center, hospital and state and federal boards. Doctors like every other human on the planet can say some outrageous things without trying but I hope you have the ability to find someone who is compassionate with people with which they are treating. I'd be more than a little concerned about the type of help I'm getting from someone who's not on board with my goals of longevity and quality of life.

This is an excellent post on 2nd opinions, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide-...

Note that the following is only similar to your situation amd in that the problem is the rising cost of cancer care and how we're going to deal with it. I don't think this at all encompasses your situation. Somewhere along the lines of allowing people to have the best of care without having the bottom fall out of the economy is the question of affordable care. What are the ethics of continuing to create treatments that extend both qol and longevity but so expensive no one can afford them. Dr. West has written asking the question, because while new drugs are being developed they are soon to out price practically everyone. Following is a post and access (I think) to the tweetchat moderated by Dr. West on the subject.
http://cancergrace.org/lung/2013/08/18/lung-cancer-tweetchat-how-are-ris...

It sounds like your doctor is inappropriately making suggestions that aren't ethical. I hope you can see someone else.

Keep us posted,
Janine

catdander
I wanted to add this quote

I wanted to add this quote from one of Grace's board members and someone who has contributed to Grace for at least 6 years. All the doctors on this board are not only specialists in their field of oncology but aggressively let us know this piece of information. Dr. Weiss wrote it as the first line in an intro to lung cancer post he wrote. This is one of my all time favorite quotes from this site, "Every cancer therapy has two purposes: to improve duration of life, and to improve quality of life. Every other measure of chemotherapy success, such as response rate or progression-free-survival, is a surrogate to these two true goals. I am using the broken record as my pseudo-apology for repeating this mantra repeatedly on GRACE, to my colleagues, and in my mind every time I make a treatment decision." http://cancergrace.org/lung/2010/04/16/introduction-to-first-line-therap...

dldl94
Great post from Dr Weiss!

Great post from Dr Weiss! Appreciate that Janine and Jim tap us newbies into these resources!
D

Dr Pennell
Hi amd5, I actually had to

Hi amd5, I actually had to pause a moment to make sure I was in a reasonable frame of mind before I answered this question. No, never mind, I'll answer the way I first reacted: your oncologist is a jerk.

Look, I (sort of) get where his mind was going. I am in a position where I am asked to help determine the value of our treatments for our health care system. When new drugs come out, we discuss how effective are they really, what additional side effects will they cause, and finally what do they cost? If they aren't better than what we already have, or might be a little better but cause a lot more side effects, and are also very expensive we might decide not to recommend them for general use. But the most important question is whether we think using the drug is in the best interests of the patient. If the answer is yes then we recommend it no matter what it costs.

BUT, that level of discussion should not enter into the actual room with the cancer patient. The only discussion your oncologist should have is whether the treatment fits with your goals, i.e. survival and/or quality of life (QOL). Cost can be an issue of QOL, especially for patients with poor insurance coverage, and I have unfortunately seen patients choose less effective treatments due to cost considerations. I have also recommended against expensive treatment when I thought the patient would be worse off with treatment than with stopping. However, to suggest someone choose death over an alternative just to save an insurance company money? No no no.

Let the policy makers have those discussions. Asking patients to decide, as if they were deciding to recycle or not or to buy a hybrid car, is simply wrong.

cards7up
Thank you Dr. Pennell for a

Thank you Dr. Pennell for a point of view that should be used by all doctors in these situations. This is a very sad commentary when a doctor says this to a patient. It's like saying choose life over death!
Take care, Judy

honorah
I have been a nurse for 46

I have been a nurse for 46 years and working for a hospice program for 26 years. I consider what your doctor said to you to be completely outrageous. I have also seen patients coming to our program very very late and when I read their histories, I think that we could have actually prolonged their life if they had not taken certain treatments when their illness was so advanced. There comes a time when the burden (or side effect) of the treatment is worse than the benefit. That is an okay to question to ask an oncologist and hope that you will get a straight answer. But to discuss the ethics about saving insurance money for the good of others sounds like someone who would not be my kind of doctor. I would move on. If you are not near a cancer center, check the Bonnie Addario web site for recommendations. I really wish you the best.

Honorah

catdander
Thank you so much Honorah for

Thank you so much Honorah for your insight. It is more than welcome! Just today I was singing the praises of nurses and the role they can play in ones healthcare. I don't know that enough people know just how valuable you are and I always take advantage of a nurses thoughts when there are questions. My sister entered nursing in 1970. And Bonnie Addario has been a hero of mine since I heard her speak at one of the patient forum gatherings. She's remarkable.

Thanks for all you do,
Janine

b-1 83
I can't believe any doctor

I can't believe any doctor would have the gall to ask such a thing! As long as you are able to fight, do it!!!!!

cancereffects
As a matter of fact, the

As a matter of fact, the title ""ethics of dying" of cancer" is really shocking..., and this is why i clicked on it to read more... Some people are radical; i guess it is the case of this doctor. Suing him is not the right thing to do, in my opinion

cancereffects
One more thing! The fact a

One more thing! The fact a physician sent you to die it does not mean you to accept the prognosis and wait for your death. Some people become completely cancer-free after they were sent home to die with terminal cancer.
Human mind has more power than we may think...