Being an Oncologist is a Privilege with Sober Responsibilities

Too often, physicians misunderstand hope by thinking only in terms of cure or remission. This flawed concept is common in the ever-optimistic oncology community. Hope can also be for less ambitious goals: for a good death, for time to mend interpersonal bonds that are in disrepair, for the resolution of feelings about divinity and a life after death, and, yes, for comforting loved ones who will be left behind. Never mind what the medical team deems important, the patient should be the author of the new standard, and it is the job of the physician to incorporate that into the dialogue and the relationship. As a result of trust and creditable dialogue, a patient should be able to completely rely on unselfish guidance in making practical choices, especially at the end of life. In this state of mind, one is better able to find closure in life and an acceptance of death, both of which add tranquility to the final stage of one’s existence.

Oncologists, even those with the best of intentions, too often fight the battle to excess and, in an effort to do something, use up valuable end-of-life time and resources. In this high-tech biomedical era, when the tantalizing possibility of miraculous cure is dangled before patient and family, the temptation to see therapeutic hope is great, even in those situations when common sense would suggest otherwise. If there are incentives for oncologists to try more treatment despite minimal odds for success, why can’t the reverse be true; that is to say, why can’t there be disincentives to go for that long shot? In deciding how much treatment is enough, the cancer physician must repeatedly address the question of what is in the best interest of the patient; that is to say, he or she should act with beneficence. Even if what is done turns out to be the wrong strategy, if the motive was for the patient’s benefit, it is morally defensible. This sounds simplistic, but in fact, pride, vanity, and perhaps even unrecognized psychic forces within physicians can complicate a patient’s life and death. Like other talented and intelligent people, physicians are not immune to the insecurity that seeks reassurance of their abilities, and whether realized or not, part of their self-image depends on success and failure in patient care.

Additionally, many physicians are extraordinarily competitive, and the instinct to “fight on” can be strong. Some oncologists seem to feel obligated to explore every avenue of treatment, no matter how unlikely the benefit. Aside from this being void of beneficence, it is financially an unsupportable strategy. My plea in this regard is for an early reality check, since the treatment decisions made near the end of life are prone to propel a dying person in a senseless direction.