Can you refuse cancer treatment even if it would cure you?

[Jinglestreet]

I'd rather not post specifics as it'll become outing. My question is as the title, can you flatly refuse cancer treatment? Say the cancer is curable and in a middle aged person. it's caught at a fairly early stage and prognosis is excellent, is refusing treatment seen as an option or could family/next of kin go down the "not of sound mind" route even if the person was of perfectly sound mind? The cancer will eventually lead to death. Would doctors support treatment refusal?

Lots of referrals turn out not to be cancer but something else.

@Piscesmumma1978 presumably because they'd like to know what's going on with their health and because they are open to certain forms of treatment for certain conditions, or maybe they are looking for palliative therapies to help cope with symptoms. Even with cancer, people may be open to things such as surgery without wanting to commit to chemotherapy or radiotherapy because they want to preserve their quality of life whilst they can. And nothing wrong with that.

Hi op, if you're going through this I'm sorry. I'm a cancer patient. All of my treatment options have been presented to me without bias and it's always been completely my choice.

My cancer was grade 4 t neg. If I'd refused treatment I would be dead I'm coming up to 10 years clear and have had chemo and rads but I'm now fit and healthy. I'm not cured but I have no cancer I've had the delight of seeing my daughter graduate and meet someone and my son has had three wonderful children. I've been on holiday and had amazing times. Yes I might have a recurrence it's the same chance as anyone who hasn't had cancer but I do know I would have missed all those things if I'd buried my head and said no.

@Jinglestreet Somehow I think the person you refer to is NOT you.

If it's a partner, friend, sibling, etc, no- you cannot override their wishes unless they already have POA, you're an attorney and want to make decisions for them ( if they have lost capacity.)

Whoever it's for, talk to Macmillan for advice/counselling/ information.

And maybe suggest they do the same.

@pippu where do you get your information from? I have many friends who went through treatment with me none have serious side effects. I had cording for a few years, gone now, my boob itches underneath my body has anything more serious

The TV images of cancer are very scary and outdated even the money raising adverts don't depict a typical day they are done to raise sympathy for support and depict an odd black day. You don't spend days throwing up on most treatments you have drugs to prevent it. It's not nice or fun but it's doable.

Every person has the right to choose what tratment, if any, to apply to their bodies.

I may or may not decline treatment for certain types or stages of cancer, being a health professional and having known a number of people who have gone through it. And god helps the one who tried to force me to get treatment once I have made up my mind. It's my body, my life, and my decision.

I wouldn't want cancer treatment and I am of completely sound mind. It's my personal belief that chemotherapy isn't and would never be an option for me, and I would of course expect my wishes to be adhered to, as it is my body and therefore my decision.

If the person wants to die then there are easier ways of accomplishing that (not that I'd recommend it- I'd recommend getting help for their issues so they don't want to die anymore.)

Please read all my post. I was quoting a pp.
My point was exactly as you say. My breast cancer treatment, like most people's, left me nothing more than a scar which pulls a bit.

Well no they don’t when it involves children. They take the parents to court to fight to give the child treatment.

This isn't always successful though

A pp mentioned people who might feel they've been through enough and have no support

When I had my cancer scare at 42, I already felt I'd been through enough and I still had a support network (who helped through a spinal injury)

Now, at 47, my support network is gone, I've had a pretty awful 4 years (2019 was good in parts) and I certainly wouldn't go through gruelling treatment to prolong life.

I can't believe I'm 47 tbh. I feel like 93. I find it hard to think over my life because too much has happened, more than I can cope with.

For some of us, life chips away, taking more strength and resilience each time.

The person also has the right to decide how they want to die, regardless whether others think that's the best way or not.

Absolutely. Informed consent is a pillar of medicine. It doesn't matter why the patient doesn't want it - if they have capacity, the fact they don't want it is enough. I remember reading the judge's comments on a case that went to the high court years ago, about whether doctors could tube feed a woman with anorexia against her will. The woman wasn't delusional, she understood that without treatment she would most likely die, but she maintained that the treatment was so intolerable to her that although she wasn't actively suicidal, death would be preferable to the treatment currently on offer. The judge ruled in the patient's favour. He said something to the effect of 'though you (doctors) cannot understand WHY the treatment is intolerable to the patient, I cannot set a precedent in law whereby a patient can state that a treatment is intolerable and you (doctors) can overule her. Tolerable is defined by the patient'. And when you think about it, that's very true. We could end up in a situation where doctors get carried away trying one experimental treatment after another, really in the pursuit of their own interests, regardless of the detriment to the patient. If the patient was delusional - say, she thought she didn't need tube feeding because she could survive indefinitely without food and water - it would have been different, but as long as the patient understands their situation, its their own decision.

Yes, you can. But there would have to be at least one conversation, potentially more, as to why you would be choosing to not treat something with a good rate of remission, that you were fully aware of the outcome (death) when that isn't necessary, and what your plans are for your end of life care- are you suddenly going to change your mind? Are you going to want all the treatment too late? Do you know how to link in with palliative services at the end. Personally- HCW and no I wouldn't 'judge' you for it, but I'd see it as a bit of a waste, sake as anyone's life who ends because they choose to end it. Because basically you're choosing a long, painful suicide.

I’m an ICU dr. People refuse treatment all the time. As long as they have capacity to do so - and we have to assume capacity, it’s a big deal to get someone declared incapable - they are perfectly free to refuse treatment. Your right to autonomy includes the right to make decisions I think are bad ones.

TBH I have far more difficulty with family insisting ppl have treatment. There are some intensely selfish immature people pressuring their elderly or sick relatives. I can’t begin to describe how many selfish arseholes have reached their 60s blissfully unaware that people die, and try to demand their elderly parents are tortured as a result. I’d be devastated if I’d treated my parents or sibling as these people do.

I know two people who refused surgery and treatment.
They were both in their early 80s and knew that any treatment would only prolong their lives for a short time, so they chose quality over quantity.

The other people (younger) I know who had cancer - or have it- grabbed anything that might stall it or even offer remission.

I'd want to know from @Jinglestreet why someone is refusing the chance of remission. Is it from ignorance about the treatment ( not aware that many sided effects can be managed with other drugs)? Is it fear of the treatment?

If someone is wishing to refuse treatment they sound depressed and not enjoying life anyway.

This was in The Guardian recently -
https://www.theguardian.com/commentisfree/2023/nov/22/my-young-cancer-patient-refused-all-treatment-after-her-death-i-found-out-why

As others have noted, there should always be informed consent (outside of emergency situations where it's impossible to get), and you have the right to refuse treatment for any reason.

For a person in their 40s to have returning cancer only a few years later, however much the oncologist believed further treatment would cure the patient, it may well not. The patient may have felt that she just didn’t have the strength to go through it all over again. She may have died anyway even with treatment, cancer is very unpredictable, or later after yet another recurrence.

No-one will ever know but a bit more humility, understanding and self-reflection were in order imo and a bit more acceptance of individual choice. I can see why that patient found that particular doctor “distressing” to talk to - she thought she knew best and wasn’t really listening. I cannot imagine recommending that someone run another marathon and then being incredulous that they just couldn’t face it.

https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

But TBH you couldn't really treat someone for cancer against their will, even if they lacked capacity.

Devastated? I have been upset in the past when patients did that, particularly when also looking after patients who had a late diagnosis and would have given anything to have early options, but devastated suggests that you maybe need to work on separating your emotions from work.....

@Mirabai I think that case a good example of what the judge was saying in the case I referred to, that tolerable is and must be the patient's definition of tolerable, regardless of whether or not the doctor understands why. Otherwise there could be no end to it, as more treatments are developed, until doctors are essentially given license to experiment on people. Even if the treatment seems harmless/benign to the doctor (as tube feeding presumably would be for a person without anorexia), it is a principle that has to be maintained in law, because of the potential consequences if it isn't.

And actually...I even wonder about some cases when a person is judged not to have capacity. Can you actually do something to someone, against their will, for their own good? The psychiatrist/philospher Thomas Szasz thought not. Or should we rather be honest with ourselves that we are doing it for some other future good, such as the maintenance of social order/the practice of medicine?

My stupid SIL tried insisting that my dying FIL be resuscitated. There was no reasoning with her, she tried suing the hospital for not doing so when he died. I felt so sorry for the doctor she shouted at, we couldn’t stop her.

I have popped back in to elaborate on what I said previously. I’m not a doctor, but a nurse doing postgrad to specialize in palliative care. Of COURSE people can refuse treatment. It can’t be forced upon you, and nor should it be. Most cancer treatments are gruelling and it’s understandable that someone might choose to skip treatment in favour of throwing themselves at living their best life while they can. The cost of treatment is enormous - physically, emotionally and financially. (Time off work, travel, parking, etc… and that’s just if you live in a part of the world where treatment is subsidized. If you have to pay for them, it can be unimaginably high.)

Where I live, medical professionals have to get informed consent from any patient before administering any medication or treatment or performing a procedure. (Even something as everyday as paracetamol or hair brushing). I was very clumsy when attempting to express this previously. I am legally obliged to ensure that my patients are thoroughly informed - and if they refuse treatment, not only would I accept this, I would then begin having a conversation with the patient about looking at ways to ensure that they have the best support systems in place to enable them to live their life the way they wish.