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?

Of course you can refuse, you can refuse any treatment. Even if someone lacks capacity or is a young child, if they won't cooperate sufficiently for treatment then it won't be given. I used to work in a cancer treatment ward and after diagnosis a small number of people just never come back. That's a shame if it's hopefully curative treatment but there's always risks and side effects, we can never say any treatment is safe and will definitely cure them so it's up to them, it's how some people cope and it's their choice.

No I don't think anyone would be judged for it, the staff know how awful the treatment can be, and what side effects people can be left with permanently. I don't know that I would definitely choose treatment if I had to make the choice having seen what people go through, before I knew what it was like I'd have said if course I'd get treatment, but now I know even some of the tests are horrendous and I'm not sure I could do it.

I had breast cancer and yes you can opt to not be treated although they will strongly encourage you to follow medical advice or if they think its just a small risk say something like its a small risk and your decision. They would not deem you lacking capacity unless they thought you lacked capacity - normally used in mental health. Treatment can be forced on patients deemed to lack capacity but that won't apply here.

Medical professionals are trained to save lives. If I knew I could save someone and they were refusing treatment against all medical advice and evidence, I would be devastated. I would want to know why, and if the patient was suffering from depression or a MH problem that was affecting this decision. If they were not, then I would have to accept that they had made an informed decision to refuse treatment.
Also, Jehovah’s Witnesses don’t allow blood products even if they can save a child or an adult. Doctors find this especially difficult to cope with, but ultimately it’s a religious choice in this case, and medical professionals must abide by this.

I think they can, and have, forced blood transfusions in the case of children before?

Fraaahnces... Why would you think it would be in any way appropriate to make it about you and your feelings? That you'd quiz the patient to get the 'right' answers and only then, accept it?

It depends whether the person is making a genuine choice and has mental capacity to do so. I have a close relative who refused hospital treatment because they were extremely fearful, needle phobic and severely agrophobic. In the end the drs managed to persuade him to go into hospital for life saving treatment. I don't think that they would have been able to force him though. He was of sound mind arguably (or at least at the level deemed necessary) and he didn't want to die. He certainly wanted to live. He was just so so frightened. I think that if someone has been through treatment before and loathed it, it would be very reasonable to have further treatment. If they flat out don't want treatment for fear of side effects etc or of not being cured, then I would strongly encourage them to meet with professionals to discuss all options.

@improb so the law regarding children is that if a child is endangered and doctors deem that the parents are not making decisions based on the best interests of the child - they can get a court order (there are also emergency court orders that are issued) to give blood. tbh in a life or death situation with a child, we would not wait - we would give blood.

gets complicated if the child is "gillick competent" - I.e. under 18 but understands the issues sufficiently to make their own decision. obv coercive control can play a role here, so it's very difficult.

Yes a person can refuse medical treatment. It might be referred to the Court of Protection, but it's unlikely that they'd overrule a capacious adult. Whether doctors would judge privately or not depends on the doctor, but other than making sure the patient knows the risks of refusing treatment, they shouldn't outwardly judge the decision.

Here's a case I remember from a few years ago where a court upheld a woman's right to refuse life-saving treatment. I'm sure there would be more recent and more comparable medically cases if you search the Court of Protection.

My uncle refused treatment for cancer (leukaemia) in his 40s and died from it.

I very much hope you’re not a medical professional. Your feelings are irrelevant. The patient is at the centre of their own care, not the doctor.

If the patient is of sound mind they can absolutely refuse treatment although I would find it incredibly hard to accept and understand if I were a member of family in that situation especially given the high chance of a cure. Its sad 😢

I don't think that's what the poster was saying at all. she was just saying that is how you would feel. and it's not really something anyone can understand until they have been in a situation where they could have saved someone's life, but their hands were tied. it is the most awful feeling to know someone will suffer and die and you can do nothing to stop them.

patients may have all sorts of reasons to refuse treatment. healthcare professionals work in the patients' best interest, so they make sure that any reasons for refusal that can be addressed are addressed. eg. patients may have been incorrectly informed about something, or they may be depressed, or they may not be aware of certain support services that are available etc. etc. we just want to make sure that they have all the right information and support. if they then refuse treatment, that's their decision. we are still allowed to feel upset about it though? we are humans after all... obv we wouldn't express this to patients.

It's doctors like you I'm worried about to be honest. Could you not see it from a patient's perspective? A decision like this isn't black and white, so many factors come into play, things about a persons life, their beliefs, their outlook etc. I wish I could elaborate.

Of course! It's a very important right for all of us, and one I would certainly consider if I were in that situation. People's individual choices about their health deserve to be respected.

I'm sorry if you've gone through very unpleasant treatment. But please don't give the impression to others (especially those having to make their own decisions) that all cancer treatment is awful.

My late DH was diagnosed at stage 4 of his cancer. While it was incurable, it was able to be treated palliatively and he went through a course of chemo. The drugs in his chemo were not the kind that have horrible side effects. He tolerated it well and it gave him 18 months of good quality of life that he otherwise wouldn't have had.

Cancer treatments and chemo 'cocktails' vary hugely. People like OP's 'friend' can very easily be put off being treated, by accounts like this, which may well not apply to their own cancer or treatment.

Medical professionals are allowed to have feelings. Of course it’s emotionally difficult to offer someone life saving treatment and have them say no. That doesn’t mean that person should not be medical professional. They should not be showing their devastation to the patient, or trying to over rule the decision of a patient with capacity. But medical professionals are humans not robots and it’s unrealistic to expect them to be unaffected by situations they encounter at work.

@IrresponsiblyCertainAboutSexualDimorphism doctors are also humans and have emptions. in fact that's what allows us to be caring and empathetic. if we didn't care about saving lives, we would all just leave when our shifts end and not give two monkeys about what happens to the patients. and caring that the patient makes the right decision is part of that.

Some of the treatment is gruelling and quality of life is different afterwards so I don't think it's as clear cut as people think. Being aware of the impact on others I wouldn't automatically go "yes every treatment possible" etc. Also "cure" for how long until you develop a different secondary anyway?

It's a tough decision for anyone and very individual.

therealcookiemonster I didn't misunderstand that poster at all.

Professionalism trumps feelings and it's the patient's wishes that ultimately should be followed. Doctors are not gods and thankfully most of them don't behave as if they are.

Thankfully, the law (as per Guardian article) backs this up.

Doctors see a lot of patients who are beyond help, so they would probably feel sadness and frustration if someone who could benefit from treatment refused it, but ultimately it's the patient's decision and a doctor will respect that.

I know a large number of medical professionals and I think they totally respect a patient's choices. A significant number of them probably also refuse treatment for themselves - they know that staying alive at all costs isn't always right. I have certainly known medics who very much want their own family members NOT to have more treatment. It is a nuanced thing, and medics see it with all the pros and cons; it's not an easy choice.

@therealcookiemonster two things come to my mind there
1- you have no idea what that person has gone through that informs their choice. It’s not just about the pros and cons and ´I’m sure we can save you, the odds are in your favour’.
2- I’m following a breast surgeon on Twitter. She also has had breast cancer - twice. She us tte first to say that, as a surgeon, she actually had no idea what her patients were going through. She was seeing them before treatment and afterwards, once most if the safe effects had gone away. Being treated herself was a huge wake up call. See too @ConflictofInterest post.

I had to sign a consent form to say my small child could have life saving emergency surgery. So I assume an adult can refuse consent.

This poster sounds like an excellent doctor to me. Making fully sure a patient has no other medical diagnoses that could affect decision making and ensuring a patient has come to a fully informed decision is crucial.

Medical professionals treat all sorts of people with all sorts of views. They aren’t there to judge but they wouldn’t probably ask on what basis you want to refuse in case it comes from anxiety or misinformation. @Fraaahnces hasn’t said if they are actually a dr on not, just their opinion if they were.