3 ms·
Chemotherapists have also faced the dilemma of whether their chief responsibility is to minimize an individual patient’s suffering or to further the search for
by M_Grey 10y ago
Chemotherapists have also faced the dilemma of whether their chief responsibility is to minimize an individual patient’s suffering or to further the search for an eventual cure. When risks to a given patient may mean benefits to future sufferers, the boundary between experiment and care can blur. Mukherjee, describing experimental chemo regimens of the early sixties, recounts the controversial decisions made to concoct terrifyingly toxic cocktails for child-leukemia patients, while the physicians in charge did what pathetically little they could to make the kids more comfortable. Years afterward, and with the clearer conscience of substantial success, one oncologist recognized the dangers of what they had done: “We could have killed all of those kids.” From its postwar origins to the present, the chemotherapist’s predicament is the precarious balance between best-practice care and the crying need to improve current practice. In the eighties, AIDS patients started to insist on being “guinea pigs,” and terminal-cancer sufferers soon followed their lead. In the current world of end-stage cancer, care and experiment can often be much the same thing.
Remember that, if you're ever in the difficult position to make a decision for yourself, or help another to make their own, regarding hospice care. Remember that you might be the one who has to realize that hope has passed, and it's time to look at palliative options. I'm not arguing against proper treatment, but there comes a time (a time which many doctors and patients fail to recognize) past which what's being done is just cruel.
- killjoywashere 10y agoI submit many of those who insist on being guinea pigs take Steve Jobs' position, "I'll be the first one to survive it or the last one to die of it", and they are really equally determined on both of those fronts. "Take me" is more powerful than "Let me go".
- M_Grey 10y agoIf that's the choice someone knowingly makes, then I can respect it. I worry that sometimes however, people like that honestly expect outcomes which are unrealistic, and suffer for it. Still, they should be free to choose.
- agumonkey 10y agoabout 20th century "early" history of Cancer, see Vince Devita book or articles about it https://www.nytimes.com/2015/12/13/books/review/the-death-of-cancer-by-vincent-t-devita-jr-and-elizabeth-devita-raeburn.html https://www.nytimes.com/2015/12/13/books/review/the-death-of...
- tominous 10y agoI think it's a bit misleading to put your advice (which is good advice) in the context of experimental treatment. In my experience the cruelty is more likely to come from applying standard treatment that is either hopeless or unnecessary. In our case it was (a) returning to a line of chemo that had most likely already failed, and (b) a pleurodesis when repeat aspirations would have been more appropriate given what the doctors had said about life expectancy. On the other hand there were novel treatments that were relatively non-invasive, safe and had a chance (I guessed about 15%) of 6+ months of benefit: (a) copying the Brighter trial and (b) low-dose intralesional immunotherapy on a palpable lesion. Both were turned out to be too hard to get access to even with the support of our physician. Yes, at some point you have to accept that the only thing left is palliative care. Beware that the window between "still trying all the standard options" and "too late to try something new" may be vanishingly small.