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?

…. unless they have MH issues, in which case they can be sectioned and subjected to forced treatment including medication and electric shock treatment.

If it's a man with early prostate cancer, it's quite common. I know several who think they reversed their cancer positive status through diet.

@AcrossthePond55 Yes in the UK it's called a Living Will (or Advance Directive) and is legally binding on the hospital as long as it's been witnessed.
It's free, unlike paying a solicitor to do Health and Welfare Power Of Attorney.Link here
https://compassionindying.org.uk/
You can also specify eg if you only consent to same sex intimate care etc if your hospital is one that subjects women to treatment they find degrading
https://archive.ph/u6S46

You can always decline but I'd think about the situation before making a decision. I could never decline and leave my young children with no mum for example if I could have been saved.

But there are reasons people decline. I just don't think any of them reasons are good enough reasons, but that's my opinion and others have there own opinion.

Can you say which particular form of cancer the person has been diagnosed as having and what his/her rationale for refusing treatment might be?

Of course you can refuse and nobody can force you to have treatment. One thing I would say is to be clear in your decision as you may not be able to change your mind. I have had a couple of patients who initially were adamant that they wouldn’t have chemotherapy. Both changed their minds at a later stage but sadly, their window of opportunity had passed for any chemo to make a significant difference to their condition.

If the person with cancer is fully informed and understood all available options then of course that person can refuse treatment.
You would hope the oncologist would already have a sense of whether this person is fit to consent, if they are then they are also fit to refuse treatment then surely?

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.

I think you could elaborate a bit without it being too outing. There are many many thousands of people currently living with cancer. If you are worried change some of the details, such as where the tumour is, (if it is a tumour), where you live, your age, number of dependants etc. Just so we can get a better idea of why you don't want to have treatment.

I have cancer and am happy to have whatever treatment my specialist recommends. I can't understand why you wouldn't, but perspective is everything.

consent-to-treatment

I had breast cancer and my treatment plan was chemo, surgery then radiotherapy. The chemo didn’t work and rather than them listening to me they kept to the plan. After surgery and radiotherapy they then wanted me to have another chemo and I said no. I was absolutely done, and couldn’t mentally or physically take any more treatment so I refused it. The oncologist was blunt and said she’d expect to see me back with a recurrence but 3 years later I’m fine. If I could go back I would 100% have insisted on surgery first and then any chemo for mop up. I also wasn’t aware that chemo only affects your outcome by 3%.
My advice is to speak to the oncologist and decide if surgery to remove it is possible (obviously if it’s a blood cancer probably not) and then no further treatment if that’s what you want.

They did make me speak to a psychologist to determine that I was of sound mind which made me hate my team even more but she said she absolutely supported my decision.

This is what I meant by judged. How is capacity assessed, does anyone know?

WhatWindyWeather, I imagine OP didn't give further information for that very reason, for posters saying that they 'can't imagine'. I wouldn't disclose either.

Parentofeanda, your post is horribly judgemental but it doesn't matter what you think of the reasons that other people decide as they do and you are certainly not a better parent.

Yes you can. They will not as others have suggested look into your mental state at all. My friend did exactly that after reading the side affects of chemo, in their case they opted for a raw food diet to improve their prognosis.

One thing tp be aware of is if you do opt out of treatment, you sort of opt out of all treatment so any scans etc. Although im not sure if you start on that track of not wanting treatment, maybe it's a bit different.

But eithef way you can opt back in again.

What do you mean by curable but will eventually lead to death?

There are guidelines here that might be helpful:
https://www.bma.org.uk/media/2481/bma-consent-toolkit-september-2019.pdf

Unless there are poor survival odds and unpleasant treatment, I would definitely view it as slow suicide, so if you have people who will be hurt by that, then that should be factored in to the choice.

If you want to die, why do you care what the doctors will think? Or are you really asking whether they’ll try to stop you?

Even the title of your OP is wrong. It’s never that black and white. There’s no ‘cure’ for cancer. There are treatment plans which may or may not be successful.

I had breast cancer. At no point did they say if you do the chemo you’ll be ‘cured’ and if you don’t you’ll die. Ditto the surgery, ditto the hormone therapy. You way up so many things. As I was quite young (35) they felt they could throw everything at me in a a ‘belts and braces’ way. In hindsight with a low grade tumour maybe I didn’t need the chemo? That destroyed by immune system. Maybe it will lead to more cancers for me in the future? It’s never black and white with cancer.

When you say “They will not as others have suggested look into your mental state at all” do you mean capacity? They absolutely will look at that.

I refused radiotherapy because the consultant would not give me any stats on the potential damage to my lungs and heart. I had already had surgery, chemo and immunotherapy and asked him to justify why RT was necessary when, as far as I could see, the potential to damage my heart and further damage my lungs was fairly high. Due to immunotherapy having damaged my lungs (I am going to get lung cancer at some point apparently if I don't have it already) I wanted to be absolutely sure that RT was going to benefit me and not cause further problems. All he would say was that having RT would reduce my chances of getting cancer again by 87%. That looks good doesn't it? After pushing it further he confessed that the 87% only referred to the actual site of my original cancer and NOT anywhere else in my body. So, he wanted me to have further treatment although the treatment that I'd received already had me at 86% survival. The consultant got more and more annoyed at me for asking the 'wrong' questions (as far as he was concerned) and when he asked me if I wanted RT or not I said no thank you. He slammed his notebook shut very loudly and told me to leave really quite aggressively.
My cancer experience has been horrendous from the start. I have been misled with the information given, lied to when I've asked questions and at my original diagnosis appointment the consultant oncologist actually refused to discuss not having treatment at all.
I will not seek treatment again. I go to any follow ups, scans and mammograms as work time allows just so that I can keep track of what's going on in my body but I will not be having any further treatment when the time comes. I have no faith that the medical professionals are actually acting in my best interests.

Some of the ladies I know going through breast cancer have had to have psych assessment before surgery, depending on the type of surgery requested vs recommended. So in theory one could refuse, but they might request psych assessment to ensure that the patient fully understands all the ramifications.

Not ‘MH issues’, you have to be a danger to yourself and/or others to be sectioned.

I used to make capacity decisions a thousand years ago. The bar isn't very high.

Can understand the procedure, can understand death, can understand the consequences of refusing. That sort of thing. And there might be other complications. Say that you're clinically depressed, untreated, and want to use cancer as the route to end your life, there would be a discussion.

It probably would help posters to understand you if you said what was happening.

@Jinglestreet the BMA guidelines posted above are helpful. If oncologists have concerns about whether you have capacity to withhold consent then the next step would be for a psychiatrist to assess whether you are “competent” to make that decision. Say for example if you had a history of psychosis and were not taking your meds and you irrationally thought the oncologist was trying to poison you. But that’s not the situation you’ve outlined.

in extreme cases the court of protection does order medical treatment to be carried out without the patients consent but that is where there is a clear case of the patient lacking capacity (the unmedicated psychosis example) or if someone else’s life is at risk (most interestingly to me as a lawyer and mother, there have been cases where c-sections have been ordered against the mother’s wishes for the benefit of the baby. Usually very young mothers with complex needs or with very significant psychiatric problems).

For a person to be judged to have capacity to make a decision regarding treatment they have to be able to understand the information about treatment, remember the information, weigh up the risks and benefits then communicate their decision.

If a person has capacity to make a decision regarding treatment and they chose not to then the doctor will respect that. They may talk the person through it and explain what will happen if they don't have treatment but they cannot force someone.

With a capacity assessment related to refusal to accept treatment, a conversation with be had with the person to ascertain whether they understood fully the risks of that decision. If they had full understanding of likely consequences and were deemed to be making an informed decision they would be deemed to have capacity. It should also be said that we are supposed to assume capacity unless there is a good reason to think it could be impaired, such as a medical diagnosis that can affect cognition etc