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?

You'd do your job and then leave at the end of your shift. Whether or not you think about your patients after that would be up to you, it's not required, is it?

I value knowledge and absolute competence in the medical profession above anything else. I wouldn't want to be treated as some sort of nitwit who doesn't know what's best for them. Ultimately, the patient's decision is the only one that matters and assuming that they are unaware of the consequences of their decision is breathtakingly arrogant. Give the patient all the information, answer their questions if they have any - and let them make the decisions they are free to make.

Yes of course they are allowed to have feelings, but to speak of being devastated if someone refuses treatment is a bit dramatic, isn’t it?

I would want to know why, and if the patient was suffering from depression or a MH problem that was affecting this decision.

may just be badly worded, but does not sound particularly empathetic.

and caring that the patient makes the right decision is part of that.

The right decision according to who @therealcookiemonster ?
You know that doctors are not Gods and simply cannot judge if a decision is the right one for a patient? Simply because they are not them.

It works the other way around too btw.
When someone is trying all avenues, decides to have one more surgery, one more treatment, even though said doctor doesn’t think it’s worth it as the chances are so slim, it’s still the right decision for that patient. Because that’s tte decision THEY made depending on their own personal circumstances.

A neighbour of mine had a malignant melanoma on his back and refused to even go to the doctor. Before that he was fit and healthy, married to a lovely lady, both heavily committed Christians (Catholic). No reason that I was aware of to end his life like that. But he did - his choice.

I find that incredibly sad 😢

If they have capacity to make the decision and understand the consequences that's their choice. We dint treat against people will (no different to JW not wanting a blood transfusion

Except that having MH issues doesn’t stop you from being competent and make the right decision FOR YOU.

MH is used much too often by HCP to push patients to get (or not get) treatment on the ground they know best and to try and over rude patient choice or experience.

The doctor will, of course, ensure that the patient has every bit of information and reassurance that they can offer them.

For instance, a patient might have known someone who had awful side effects from treatment, and not want to go through that. So they might decide to let nature take its course, only for that fear to be unwarranted. The treatment for the kind of cancer they have might be very different, and not remotely as traumatic. So the doctor will want to be sure that they are not making such an enormous decision based on a misapprehension.

No doctor wants someone to refuse life saving treatment, if there's anything they can do to reassure their patient. But they will not and cannot force them to have treatment. The doctor won't judge, but of course they'll be sad, and possibly think they've failed, if the patient still refuses. But they won't say so.

My cancer related, but I work in a field where people make decisions that out theirs or their baby’s life at risk. I never judge, but always do my best to ensure they know the potential outcomes of their decisions and the alternatives available.

It is your life and your body to do with what you will and I would always support you and your decision.

Do you know the reason for their decision OP?

Absolutely anyone can refuse treatment for anything as long as they have mental capacity.

Not wanting curative cancer treatment is not a sign you don't have capacity, unless it's part of a mental illness. Even then, it's not realistic to pin someone to the bed each time they need chemotherapy.

It isn't common but I do see people who have refused curative treatment on and off - as it always ends badly.

Sometimes I'll know the reason why and sometimes not. Usually beliefs about medicine and health are key factors for example thinking alternative medicine will be better, chemotherapy is 'too strong' or faith based reasons such as 'if I pray I will have a miracle'.

It generally makes medical staff feel quite sad for the patient as they know it could all have gone another way, especially as the patient usually ends up with a pretty grim end of life experience.

They would want to make sure you understood the consequences of your decision, and try to persuade you to change your mind, but I wouldn't say judging and they can't force you to do anything.

We went through a similar situation. One of my cousins was 25, had stage 3 bc and didn’t want chemo because she didn’t want hair loss. Her NHS oncologist stressed why she should have it, told her monitoring bc isn’t a foolproof option because it can go from 2-4 in a year without treatment but she was insistant and so they had no choice but to stop treatment.

But she did have a 2 and a 1 year old and as the doctors thought her decisioning was odd, referred in social services who made her life hell. Her DH eventually had to leave her to keep custody of the kids. In any case she died last year of bc at the age of 30. Lost her kids, lost her DH (he remarried quickly - as kids were so young they forgot my dc and eventually the family decided it was better for them if she didn’t see them). And all for a bit of vanity.

A friend of mine refused cancer treatment. I wont go into the ins and outs but her doctors discussed it with her and it was very much her decision.

Interestingly, for many, it's doctors like this that are important. Doctors who actually care about people and saving them, care about mental well being.

It’s doctors like @Fraaahnces that dedicate their lives to helping ill people that I am thankful for.

Doctors are trained to treat people but are also trained to deal with life and death outcomes, they want the best for their patients @Jinglestreet & are well aware that, for a variety of reasons, not everyone will be treatable or recover.

If this is being taken into account by the patient making the decision then you'd have to wonder if they are indeed of sound mind and if they fully understand the gravity of the decision.

With the 20/20 vision of hindsight I so wish my husband had declined the surgery which was meant to ‘cure’ his liver cancer.
Admittedly his percentage chances of success were high, but some people are going to be the unlucky ones.
I feel so bitter that the 5 year survival rate quoted with just palliative treatment was actually much worse than later research has led me to believe.
When the life saving treatment has the capacity to kill you it HAS to be the patient’s choice if the have the information and understanding to make that decision.

lol you have just demonstrated your own point beautifully

I am a survivor of almost 20 years of serious health issues and have undergone chemotherapy, multiple surgeries etc. etc. as well as being a doctor. I'm not a doctor who just goes around imposing my will on patients - obviously because given my specialty that would be assault.

any medical professional worth their salt takes a good history and tries to find out what the patients mental state and viewpoints are based on.

I am 100% not saying doctors should dictate patient choice. I am saying there should be a multiway discussion between the patient, the doctors, specialist nurses, community treatment teams etc. etc. to help the patient make the best decision for them. that may in some cases be refusal of care.

either way, we are emotionally invested in our patients.

A doctor is likely to try to persuade the patient to do the treatment because it’s their job to help people get better and they wouldn’t be doing their job properly if they didn’t urge ill people to make choices to recover their health. But ultimately the patient has to consent to any treatment.

Speaking from experience as a cancer patient, cancer treatment is horrible, but far better than the alternative. Death from cancer is extremely painful for the patient and for the people who love them. I agree with a PP that your friend might be wise to discuss their feelings around treatment in a non-clinical setting.

Nobody knows what anybody actually does for a job here. I've seen quite a few 'nurses' caught out over the years so I don't automatically accept whatever anyone says as the truth. Better that way.

This article is discussing this sort of situation from the doctor's point of view OP so may be useful to you: https://www.google.co.uk/amp/s/amp.theguardian.com/commentisfree/2023/nov/22/my-young-cancer-patient-refused-all-treatment-after-her-death-i-found-out-why

Anyone can refuse anything. The doctor would want to know that the person refusing was fully aware of the implications but unless the person was deemed not to have capacity no treatment would occur if declined.

Maybe some counselling/therapy would be offered/needed to help the refuser be certain of their decision. I don't think they'd even need to tell the doctor why they didn't want treatment though, just that they don't.

Yes. A relative had stage 4 and refused radiation recently. It’s your body. Also if you watch ‘cancer and me’ you’ll learn to your horror that chemo, for example, only helps a very small minority of the people it’s given too and often leaves them with catastrophic result.

About 5 years ago I looked after a 3 month old baby in liver failure who was going to die unless she had a transplant within the next few weeks. Her parents were Jehovah’s Witnesses and refused to consent.

The hospital took the family to court and they were awarded the right to make all decisions regarding the medical care of the baby regardless of the parent’s wishes.

Thankfully the baby had her transplant about two weeks later and I got the impression the parents were very relieved the decision had been taken out of their hands.

@Fraaahnces "I would want to know why ..." How dare you!
@Jinglestreet People with cancer do sometimes accept treatment out of fear of others' judgement instead of a place of knowledge so I understand where you're coming from on this. It doesn't have to be an "either/or" decision, though, also there may well be options and plans, once made, can be changed. I found Macmillan nurses and an oncologist very helpful pre-decisions and hope you have someone equally supportive.