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?

I knew someone many years ago who made that decision too. They had very young children, couldn’t face the side effects of chemotherapy (this was when the drugs used were pretty brutal and unrefined unlike today)
Obviously it’s a very personal, very difficult decision to make. As a nurse I had to support my patients with their choice.

@porridgeisbae

Dear god - that is the biggest bunch of shite that I've read on this thread but thank you for the condescension

I am sorry for what you've been through

this statement is really helpful to me. Thank you.

I’m not entirely sure what you mean by doctors “judging” you.

I’m a doctor, and I have opinions on every single patient I see.

Most of the time it’s a fleeting thought - a patient is straightforward, has a problem, wants it fixing, has some questions, takes the tablets or whatever - I barely think about these situations.

Other times I see patients about whom I have strong opinions. Sometimes I like them, sometimes I dislike them, sometimes I’m saddened by their misfortune etc. If I saw someone with an easily treatable cancer who refused treatment, I would think they were rather foolish. If they had kids then I’d think they were selfish.

But whatever they do, whatever path they choose, I never ever let my patients know my opinion. I simply state the facts as they are, and allow them to make their own choice. I make sure the patient is fully informed of the pros and cons of whatever decision they are making . Then I’m done.

So yes, a doctor will judge you, in their own mind. But a good doctor will not share those thoughts.

@Fraaahnces Assuming that the patient is an adult and isn’t suffering from a phobia or other severe MH condition, I think it’s none of your business, tbh.

Not everyone is bothered about having a long life, they may be content to die at 50 or 60 if they develop a terminal condition (terminal without treatment, that is). For me, my attitude is influenced by my children’s ages. Right now, they’re teenagers so I’d definitely fight to live; once they’re independent adults, I may not fight so hard.

I think this is a difficult question to answer because it very much depends on the type of cancer.

For the cancers I work with the treatment is pretty gruelling, and even if "cured" can still be life changing. No treatment is always involved in the discussion, and something we ask people think about is will they cope with surgery, will they cope with subsequent radiotherapy/chemotherapy. Obviously discussions about the level of treatment someone wants would also be had, if someone declines treatment is there something we can offer which will prolong life/maintain quality of life that they would prefer. I would also want to know if there was anything that we could do that would help them or if they had any worries that we could address

Obviously I would make sure they were fully informed and understood the decision they were making, this is different for every patient.

Ultimately medicine 101 is that patients with capacity have the right to refuse treatment. It is not my place to judge someone. I have had patients refuse treatment and I find it sad when they die, but no more sad than any of my other patients who die of cancer.

This is very true.

I recall a patient who strongly suspected she had breast cancer but didn’t see a doctor because she didn’t want to go through nasty chemotherapy, with all the pain and sickness and so on. So she ignored the lump, and chose to let herself fade away without unpleasant medical intervention. Except that isn’t what happened. The tumour eroded through her skin and became infected, soaking her clothes with pus and exudate. It began to smell, and hurt a lot, so she couldn’t ignore it. It took her about a year to die, and she had a really tough time of it. I remember her telling me that she wished she’d just seen the doctor when she first found the lump. It was very sad, I really felt for her.

Also I disagree completely that I am trained to save lives. I am trained to provide medical treatment, sometimes that is saving life, sometimes that is ensuring someone is comfortable and sometimes that is not providing treatment. Saving lives frequently isnt the best thing for someone.

I also know that there are situations where I too would not accept treatment for cancer. I would be a complete hypocrite to judge.

This explains the cases/law regarding the needle phobic patients I mentioned earlier. So it’s not quite as simple as saying as long as someone can explain the consequences of their refusal then they can refuse. Because these two could explain that. I admit i don’t fully understand the legal aspects because to me it seems to contradict itself, the article says people can make irrational decisions and that’s ok. But it seems if you make an irrational fear due to needle phobia then it isn’t ok. https://www.uhs.nhs.uk/health-professionals/clinical-law-updates/needle-phobia

Obviously this relates to needle phobia but I’d imagine the case law could be brought into similar situations.

I think I’d expect a doctor to be asking questions around mental health if someone refused treatment for a cancer in middle age, when treatment would cure it, that sounds like a decision with an awful lot of spot her issue going on behind it. Generally most humans have a strong survival instinct, they are usually suffering with mental illness or other physical illness like constant pain, to just “give up”
so, I’d hope the individual will be given a full mental health assessment and some counselling before doctors just give up.

What are your reasons for refusing? I believe you can refuse any treatment but people will try and convince you to take it especially if it is going to be a cure

I know of someone who refused treatment as they believed in ‘natural’ cures. They were listened to, and died much much sooner than they could have. They changed their mind in the last few weeks but it was too late.

Both my parents died of cancer and I watched them so yes I do know. Thank you very much 😊

A patient who has not been to a doctor and therefore did not have the opportunity to discuss their options is different to someone who has and is fully informed

I would assume all these discussions will be had with OP. It's not just going to be one quick "oh you don't fancy chemotherapy, cool". Explanation of whats going to happen if the patient declines treatment will obviously be had. Your poor is pretty patronising

@MumblesParty I'm really sorry about your friend

But ignoring is different than choosing. She could have had the lump removed and refused chemo, radiation etc. a lump or tumour takes on a life of its own.

It sounds like she literally ignored it, which it totally different than discussing options, including palliative care. Was she maybe worried about being forced into chemo?

I wish it was easier to make people undergo treatment for health conditions they should have for their health but don't. The person would be glad of it in the end when it has made them well or as well as possible. To give the most frustrating example, anorexics who refuse treatment and it's pretty much impossible to make them have it.

Sorry but not all cancers are painful. I've known two people with cancer in the mouth, both said there was no pain. My grandma died of lung cancer, little pain, a hell of a cough, but she was not on any painkillers at all, even when the end came.

Cancers are as varied as the people who get them. Some are only bearable with opiates, some need less pain relief and others still, nothing.
One of my friends with oral cancer, didn't even know she had it till a routine dental visit. The other had a large growing mass on the side of his face, assumed a ulcer.

<headdesk>

you'd probably have me in ECT by now, screaming "You must value LIFE!"

@housethatbuiltme There may be no 'cure' but there is long term remission.

I think we all know (of ) people who are still alive 20, 30 or 40 years after having had treatment.

You dont get to choose if you die of cancer. OP has zero say in that she only has say in what medications or surgeries/procedures she has done.

Even of those in treatment most will die, quarter of deaths in the England (167,000 people across the UK) are from cancer... thats 1 in 4 people who die. Its not because all those people refuse treatment most had some form of treatment but you don't just 'get over' cancer.

The answer to your post Op is that of course you can refuse treatment for anything, regardless of prognosis. However, medical professionals have a duty of care to consider patients holistically. This will include ensuring that a person doesn't make a knee jerk decision about something due to shock, fear or another reason. On the face of it, refusing treatment for a condition that is curable but would otherwise lead to death is unusual and a dr would want to talk through that. This doesn't mean you can't refuse treatment. More common, is the decision to refuse treatment in a situation that is definitely going to lead to death and where treatment may compromise other quality of life areas. In this case too, you would be given all.options but it would be more common for a patient to choose to finish with treatments. A common example of these two options might be a very early cancer such as melanoma, bowel or breast where the odds are extremely positive when treated early but a later stage, metastatic cancer would lead to death. I hope your friend is able to see these perspectives clearly and to understand that choosing to select the definate death option at such an early age would most likely mean lost years of life opportunity and probably impact more people that they imagine. You don't say whether your friend has a partner or children, but either way, none of us exists in a vacuum and would be missed if not here.
Best wishes in the decision you make

You dont get to choose if you die of cancer. OP has zero say in that she only has say in what medications or surgeries/procedures she has done.

And choosing treatment can vastly improve the person's chances of not dying from cancer. People who refuse treatment are choosing to die of it really.

Most don't increase your chances of not dying of cancer though, there a serious lack of understanding most people here have.

These treatments do not 'fix' cancer, they buy time and for a few lucky people that might get decades of remission (not 'cure' but remission... which means a temporary halt in severity of pain & disease) however for most its a few years with serious health complications.

Most who undergo treatment still die either of cancer or of side effects of treatment and even many of the lucky few that don't die OF cancer will die with it in some form.

The best chance you have is if you have a tumor completely and successfully amputated or excised and with no cells have broke off but other options for cancers that cannot be removed or have already spread are not the magic cure most here seem to think they are.

Chemotherapy is still just as brutal these days for many cancers. The drugs I had had been around for yonks. It’s a shame we haven’t been able to find more gentle treatments.