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Running head: The value of autonomy with cancer patients

The value of autonomy with cancer patients

Wadih Khnaizir
Lebanese American University

The value of autonomy with cancer patients

Abstract
The importance of transparency with cancer patients is surely an essential
idea to discuss. The patients life and struggles was never discussed exhaustively
with complete detail even though it is the most important topic to discuss when
cancer is the main topic at hand. By referring to several databases, books, and
professional interviews with doctors and even with patients under treatment, I was
able to come up with information of great benefit. The importance of transparency
was discussed to show how it could affect on a psychological and on a professional
level too. The results obtained are vague and somewhat undecided since arguments
from different levels contradict and the information is missing to take a final decision
on how adjustments and amendments can be made to what has been previously
available. However, the conclusion came up to be that transparency is essential and a
priority in treating patients and to prove the latter, real-life examples were stated.

The value of autonomy with cancer patients

The value of autonomy with cancer patients
Outline
Claim: Doctors should be completely transparent with cancer patients in relation
to their cancer
I. Psychological
A- Transparency weakens the patient
1. Depression
2. Demotivation
B- Transparency supports the patient
1. Strengthens
2. Motivates
II. Professional
A- Should not abide by the AMA code
B- Should abide by the AMA code

The value of autonomy with cancer patients

Lost in a maze of imbalanced care, cancer patients struggle and face a lot of
encounters that affect them psychologically and might lead to significant gloominess
throughout the process of handling. This is why autonomy with cancer patients plays

The value of autonomy with cancer patients

an important role in helping the patient in a way that alleviates the barriers that the
patients have to cross and shapes a route of encouragement and precaution for the
patients to be guided with complete transparency away from any hidden information
or detail. This is why the matter at hand alarms doctors in particular and
demonstrates the importance of doctors being completely transparent with their
patients. A lot of disagreements exist on how the way transparency is handled can be
modified to suit everyone and help in a way where no harm is present and is all given
by related and concerned people on this specific topic. Arguments have been ongoing
on how transparency weakens the patient and how the oath doctors follow can be
adjusted to work better on such cases. Some professionally-related people agreed and
some disagreed and this is why the matter is a never ending dilemma to be stressed
on solving.
There has been a lot of controversy on the psychological level, some people
claim that transparency with patients leads to depression. Cancer is a chronic illness
that causes continuous suffering to patients and their relatives. The pain to the patient
can be social psychological or physical. The decision to disclose all the information
about the patient to them has been a controversial issue. Some people argue that
disclosing all the facts to the patients is beneficial while others disagree.
Psychological effects are the greatest form of suffering to a cancer patient. One form
of psychological suffering that cancer patients undergo is depression. Disclosing
their prognosis to them is one cause of depression to cancer patients. This is because
not all medical doctors will accurately determine the prognosis of the cancer patients
and provide the patients with accurate information (Baumgarten, 1997, p.74). By

The value of autonomy with cancer patients

hearing some of the prognostic statements, many cancer patients become uncertain
of the future, and they are attacked by depression and nervousness. The idea of
restricting freedom and checking out over cancer patients should not be avoided. Due
to their psychological sickness, it is important to restrict their freedom to some
degree, which is therapeutic. This is because if the scientific and the ethical basis of
patient autonomy are followed to the letter, the outcome is likely to be a
psychologically weak patient. The dignity of individuals is not degraded by
restricting freedom since the doctor has the responsibility to prescribe care that will
lead to the well being of the patient. A patient who is undergoing depression is
undergoing a main stage in the disease process, especially when they get their news
about the cancer disease which is sometimes a shock since the patients had no idea
about their case. The patients in this stage are psychologically disturbed because they
want to search for the most suitable solution to their problem. From the doctors
perspective, this is like a normal stage in the process of the disease and is likely to
pass with time (Baumgarten, 1997 p. 89). During this stage, interventions need to be
implemented to terminate or reduce depression in these patients. The best
intervention that the doctors can give to the patient is providing therapeutic
encouragement and good news. Social interactions and communication to the patient
are of vital importance. They play a role making the patient feel important and thus
avoid the depression. Other than depression, there has also been a lot of controversy
concerning the demotivation that lack of transparency leads to. A period of
demotivation may occur due to the nature of cancer disease. This may be caused by
treatment failure. Many cancers are hard to treat, or they may not respond to

The value of autonomy with cancer patients

treatment at all. The probability of treatment failure is thus very high. In many cases,
the treatment failure does occur. When it occurs, the doctor does not lose hope but
continues with treatment. This is because the doctor has taken an oath to continue
ever being hopeful that a patient will get well. On the other hand, the client loses
hope with the treatment and the doctor. The relationship between the client and the
doctor worsens. This causes the condition of depression on the client to deteriorate
(Pellegrino, 2012 p.15). At the stage of deteriorated depression, demotivation is at
the peak. This is because depression and motivation go hand in hand (Pellegrino,
2012 p.28). The main goal of the doctor at this stage is to address the two main
problems of demotivation and depression to know what the problem at hand really is.
The difficulty the doctor encounters is the attachment of the two and their tendency
to go together. Nevertheless, the doctor does not lose hope with the client. Another
way of strengthening a cancer patient who has such kind of suffering is by divulging
all the information to them. Giving information to patients about their condition is
therapeutic in nature. The advantage of transparency is that it enables the patient to
know everything they should know about their disease condition. It is the right of a
patient to know the information about their disease condition. Getting the
information about their disease will help patients to make decisions about their
future, in relation to their disease. The patient is strengthened psychologically by this
form of honesty and will definitely be stimulated to resume with the treatment and
move on. (Gross, 2005 p.791). At the same time, giving information to clients helps
them relieve stress and calm the mind. The relationship between the patient and the
doctor is likely to be restored due to the honesty of the doctor. By discovering that

The value of autonomy with cancer patients

the doctor is honest, the patient is likely to renovate their hope in the doctor and to
complete treatment (Jens, 2002 p.253). This revives the strained relationship that had
deteriorated between the doctor and the patient. The doctor has made an achievement
for not losing hope. At the same time, the doctor is now in a good position to
encourage the patient to complete their treatment. A task that presents itself to the
doctor at this point is ensuring the patient completes the treatment and that the
patient will have a productive life after the treatment. For the doctor to achieve this,
they have to instill determination and hope to the client by being transparent.
On the professional level, the disputes were many and were all related to the
oath all doctors are obliged to take. Doctors in their treatment of cancer patients face
a dilemma because of the oath they took to abide by the ethical code of conduct.
Although they took this oath, doctors still are supposed to practice by application of
reasoning and common sense (Varelius, 2006 para.8). They cannot succeed in the
administration of care if they will not exercise common sense and reason. For them
to help patients and realize positive results, they have to exercise independence and
personal decisions. By doing this, they will realize the best outcomes for their
patients and they would be offering the elite treatment undoubtedly. The technicality
of the oath places many doctors under difficult circumstances in their practice. This
is because once it has been taken; an oath should be taken to the letter. Adhering to
this rule is difficult in some instances. This makes many doctors campaign for
changes and review of the oath. These doctors see the oath as a barrier restricting
them from using their vast knowledge in devising various ways of benefiting the
patient (Varelius, 2006 para. 12). Their argument is that changing the oath to allow

The value of autonomy with cancer patients

them to think independently without restrictions will have far reaching benefits to
them, their patients and the relatives. The result will be a healthy nation. Another
view about the aspect of an oath concerns the obligation of the doctor to provide all
the information to the patient without any imprecision. This view obliterates that
doctors have an obligation and the responsibility to inform the patients on their
condition on a time-to-time basis. Thus, physicians should practice it even if the
change of the condition is insignificant. The importance of this is to give the patients
the information required so that they can be better placed to make a good decision
about their health status. The patients have the right to decide by their own, and to
self-determine their own treatment (Vareluis, 2006 para.12). If they wish, they can
exercise their right to refuse treatment. The aspects of the practice of professional
standards have to be put into consideration by the doctors in the care of patients with
cancer. The doctor has to adhere to the professional code of conduct as outlined in
the code of conduct they signed, and as provided in the oath they took. The doctor,
therefore, has to be dedicated to offering enough time and honesty to the patient they
are caring for (Loewy, 2007 p.3). Observance of the law too is an obligation of the
doctor. In the event of controversial issues, the doctor should explore the available
solution so that the case can be solved expediently. The reason that an oath guides a
big number of people is the determinant of the terms and conditions as well as the
contents of the oath. The oath should fulfil the condition of being believed by the
majority of the people who take it (Loewy, 2007 p. 5-8). For example, doctors should
believe that the oath they take is the best for them. It is, therefore, liable for
acceptance by all the doctors. Although it satisfies many of them, this does not

The value of autonomy with cancer patients

eliminate the possibility of complications that may be brought about by the oath.
After taking the oath, dilemmas may still be there. The oath doesnt completely solve
the problems some doctors believe should be resolved by adjusting and amending the
oath. The observance of medical ethics and transparency are of vital importance in
the profession of medicine, in particular, and health in general. This is because
medicine deals with the very sensitive part of human beings; their body which is the
base of a persons life. The ethical code of conduct outlined in the professional code
must be followed to the letter with thorough meticulousness and mistakes are
definitely not an option. Transparency to the patient too should be given a priority
since a patient should be aware of the complete process and everything that is
happening to him/her. The doctors who believe that the rules should be changed are
out of the law and work independently in a way they believe is the appropriate way
and that all doctors should follow without any hesitation. Failure to observe ethics
can lead to immense disadvantages to the patient or to the doctor, or to both. For
example, if a doctor agrees to treat a child without the parents approval, the doctor is
putting himself or herself in risk. In the event that the condition of the child
deteriorates and maybe the doctor loses the patient, the doctor has to bear
responsibility for the life lost. The doctor may serve a life sentence because of their
decision to try to save a life. This exemplifies why doctors should be very careful
with observance of medical ethics (Terdin, 2009 p.16). In addition, it shows how
essential precision and perfectionism are for a doctor and that the work they do
should never be taken for granted because it determines the lives of people suffering
from several difficulties that has been discussed.

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The value of autonomy with cancer patients

The decisions doctors take concerning treating their patients might be
agonizing and this is why we conclude that the importance of transparency and the
doctor-patient relationship is highly important and assists the patient to reduce all
forms of depression and stress that might result from hiding or delaying the
information a patient should definitely know about his/her cancer. Thus, prioritizing
transparency is an obligation after a professional doctor has given an oath to respect
such a requirement and after being a true doctor willing to help as much as possible
to advance and reach a stage where a patient is treated just like a family member
with the full care and precaution obtainable.

References
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http://www-personal.umich.edu/~elias/Courses/442/autonomy.pdf

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The value of autonomy with cancer patients

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Gross, M.L. (2005). Forcible treating competent patients: the significance of
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Varelius,J.(2006,December). The value of autonomy in medical ethics. Retrieved

December 4, 2013 from
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