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?

No one can force anyone to have treatment they don't want but I imagine they'll make a few attempts to explain the consequences and maybe even get to the bottom of the reasoning.

Is it for religious reasons, believing God or a religious figure will grant healing? Is it ideological, believing the system wants to over-medicate/poison? Is it ultimately just not wanting people prodding and poking?

Ultimately no one can force anyone to have treatment against their will but people might try to get to the bottom of the reasons!

With treatment, probably curable. Refusing the treatment, probably will result in a sooner death. As has been pointed out in the thread, nobody really knows, nothing is black and white, even with survival percentages as a guide.

Alternative to what? Effective how? If you are talking about untested, unsubstantiated alternatives to actual medicine then do fuck off and stop selling false hope. Alternative medicine has either not been proved to work, or has been proved not to work. Don’t contribute to the tsunami of misinformation out there. It is one thing when a person with a cancer diagnosis looks at all their treatment options and decides they want some but not others, or that they don’t want to put themselves through the pain of treatment and would rather accept they will die from their disease or die sooner. It is an entirely different matter when a person facing a cancer diagnosis has been missold pile of shitty false promises about untested, unproven or disproven ´alternatives’ and so mistakenly believes they will be treated or cured.

@Delatron

I think your post highlights the vast differences from area to area. I was absolutely told that my treatment would 'cure' me. At no point did they say that the immunotherapy could cause 'issues' later and none of the forms detailing side effects said it either. They gave me 3 days notice of starting chemo and rushed everything through so quickly I didn't have time to think or question or properly prepare myself or family. It was turn up at the chemo unit, sign these forms with a "no there's no time for you to read them just sign" and then they were trying to insert a cannula. It was so fucking horrendous I still have flashbacks.

I know someone who did this. They thought they were taking the easy route. Their death was slow & horrific, so make sure you fully understand what will happen to your body & how death is likely to happen.

If I could turn back the clock, I would not have consented to treatment.

I don't understand why you think Drs would judge. They would certainly express concern and, acting in your best interests, ensure that you fully understood the options and consequences. They wouldn't judge you though.

Did you really just quote a comedian to belittle someone.

Lots of non western used medicines have been proved to work through a history of use. Also a lot of people would be surprised to know just how much we use that is NOT actually tested or proven safe.

Some of it depends on the age of the person. An elderly person would probably be assessed by a geriatrician initially, maybe have a MOCHA done by an OT and also have to speak to a psychiatrist.

Anyone else, over the age of 18 would probably be spoken to by the oncologist initially, then assessed by a psychiatrist, then the person's solicitor would probably get them assessed by another psychiatrist before finally ending up at a hearing where medico-legal judges would decide.

It’s really not that easy to have someone declared incompetent or mentally unsound, just because they want to decide for themselves what treatment the do/don't want. Any doctor who wanted to take this route would have to be fairly certain that it would lead to the judgement that they were looking for. It’s extremely costly as well for the NHS Trust or public hospital (if you’re not in the UK).

I nursed someone who had refused treatment for a very easily cured cancer. Long story short, they died, and I often think about them, and all the other patients I’ve lost. It’s heartbreaking and I know that people have this whole thing about medical practitioners don’t have feelings and need to maintain professional boundaries, but it’s hard. When you look after somebody for a long time, care for them to the best of your ability, get to know their family, it’s bloody heart-wrenching.

Ultimately though, the patient is always at the centre of the treatment plan and their wishes, assuming they are of sound mind, will be taken in to account. Good practitioners will want to help the person to draw up a plan for their care, especially for later on, once the disease has really taken hold and the patient may not be able to verbalise their wishes at that point.

PM me if you want further information or any assistance 🌺

Doctors are human beings and they may judge the person ( especially say if they had young children) but would hide that judgement from them in discussions and not use it as a lever to get someone to comply. Well they shouldn’t anyway. Obviously as in all professions there are always outliers.

Basically the legal requirement under the Mental Capacity Act is a 2-stage test:

1. Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?
2. Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Where appropriate, people should be allowed the time to make a decision themselves.

The MCA says a person is unable to make a decision if they cannot:

• understand the information relevant to the decision
• retain that information
• use or weigh up that information as part of the process of making the decision

It's quite a low bar and, for instance, people with learning difficulties are more likely than not to have capacity. Perhaps most importantly, the fact that you are making a decision others may think unwise doesn't automatically mean you lack capacity.

There's a lot more information about the process here - https://www.scie.org.uk/files/mca/directory/mca-tailored-for-you/health/pan-london-commissioner-toolkit/beh-capacity-assessment-tool-guidance.pdf?res=true

But the important thing to bear in mind is that the refusal of treatment doesn't automatically trigger this process. The medical professional would generally have to have other reasons to believe the patient might lack capacity.

I wonder whether you have yet had the in depth discussion with your oncologist? Are you making decisions based on rumour, friends and relatives experiences?

If it's some kind of fear or phobia they will bend over backwards to help and accommodate you.

My oncologist absolutely said to me "we are aiming to cure". He could say that because the scans and biopsies gave hime the detail about my cancer.
It's true they never say cured, contary to popular myth no one is ever declared cured of cancer. NED No evidence of disease is what you get.
Many hundreds of thousands of people are living to a healthy ripe old age after having cancer treatment. Like my aunt who is 93 and had breast cancer 40 years ago.

Informed consent.

'capacity' must surely refer to whether someone is able to understand the pros and cons.

If this is YOU @Jinglestreet , unless you have diagnosed dementia, or a MH issue, then it's hard to prove you are not able to understand.

If it's a relative and they are refusing, you can't prove non-capacity unless they have a diagnosis of something AND you or others have power of attorney for Health and Welfare.

Your question makes it hard to answer. I am thinking this is a family member and you want to override their 'no treatment' choice.

You can't do that unless you have POA and they are not able to make decisions.

If it's YOU then your family can't make a decision for you either.

If you say it's likely to be cured with treatment, I'm struggling to get my head around the declining it option. Unless you want to die or don't mind dying. I'm assuming children aren't involved as I can't imagine a parent wanting to put their child through that unnecessary trauma. You haven't given much information but no someone won't be forced to have the treatment, you can refuse.

Sorry @Jinglestreet, I should have said “easily treated cancer”, not cured. And some cancers do have a really good outcome if caught early enough, and you can go into remission and that cancer never return. It’s a hard choice though and quality of life needs to be thought about, not just quantity of life 🌷

Do you know the trauma of watching loved ones suffer and die anyway.

There is no such thing as 'cured'.

Do you know what its like to watch a loved one vomit until their teeth desolve and fall out and cry themselves to sleep waking up screaming in pain, unable to eat, struggling to look at themselves in the mirror, going in and out of hospital with complications of surgery and then dying slowly and horribly of things like sepsis.

So much better for kids to see that.

Oh that sounds awful @MothralovesGojira sorry you went through that.

There is a huge difference unfortunately from hospital to hospital and area to area.

I was very much given a choice and told about potential side effects. What I will say is that I do think my team made it very clear what they thought I should do (all of it). For example I had a double mastectomy- for a lump in one breast. I had the surgery first and then chemo so more time to think.

Yes you can decline treatment.

It's hard to prove that an adult doesn't have the capacity to decline unless they have a relevant neurological or psychiatric diagnosis that's quite severe and even then, it isn't straightfoward. There is I believe such as a thing as a Capacity Assessment.

The assumption otherwise is that they do have capacity and a person is allowed to make 'unwise' decisions - that alone doesn't 'prove' that the person has lost capacity.

(IANAL)

I always like the case of Mr C who I think established the principle that people are entitled to make decisions that doctors don't like. Basically he was a schizophrenic who refused the amputation of his gangrenous leg believing that God didn't intend him to leave life with fewer legs than when he entered it. The court went to considerable lengths to get and pay attention to his views, and ultimately decided that they should not be overridden. And ultimately he proved to be right because he recovered without the amputation.

https://theconversation.com/meet-the-man-who-gave-you-the-right-to-say-no-to-your-doctor-22568

You're worrying for nothing @Jinglestreet .

To be assessed as having capacity you only have to show you understand the information that is given you, and that you can retain it and use it to make decisions about your health. The bar really is very low unless you are a child. And, the reality is, even if you agree to treatment you can just not show up to receive it. No one is going to show up at your door and drag you.

Firstly, may I just say to all those who feel their cancer treatment was problematic, I'm sorry for what you have been through.

Dad's treatment was definitely too aggressive and death by that route is horrendous. Of course there is often no good death with cancer but the least traumatic ones I've seen have been by refusing treatment. least traumatic by far. Proper palliative care is key though.

There's a lot of uncertainty around treatment.

Secondly, in case it helps OP or anyone, another anecdote. 20 years before his death, dad had a highly controversial surgery (he didn't have cancer at this point.)

He was told he'd die of heart failure without it, but he had a good chance of dying on the table or shortly after, about 70% they said.

He opted for surgery but was quite blunt that if he didn't have a wife and children, he'd have been all right to die.

I think it's taboo to say you don't mind dying but probably a lot of people don't mind and don't want to buy an extra few years.

I had cancer twenty five years ago. It was awful, I was very frail, had a very traumatic major surgery and six months of chemo but since then I have had good health and two children. If the prognosis is good why would someone (not elderly) refuse treatment?

I'm not a doctor (I am a nurse).

People have the right to refuse treatment. There are very few circumstances where treatment can be given without consent (Mental Health Act / Mental Capacity Act / Court of Protection) and these are more limited where physical health is concerned.

If I was speaking to someone who declined treatment I would want to make sure they understood the risks, the same as I would want to make sure they understood the risks of treatment and that they were making an informed decision. I would ask their reasons for declining to check mine and their understanding of their situation and make sure they had all the information they needed. I would ensure they knew what options they had if they changed their mind (same as if they started treatment and changed their mind) and knew what support was available whatever they chose. I would respect their choice.

That said, I am a human and I care about people, while I can respect someone's choice it is sad knowing it will lead to a sooner death so I might feel sad about it. I can still support it being the right choice for someone and feel sad. Sometimes there are no good outcomes.

My very elderly aunt did. She had had surgery and chemotherapy which her consultant said was very successful. But when a scan showed it had returned she said she didn’t think more chemo was worth it and would rather see out her days in palliative care. Which is what she did.