Real-Life Decision Making -- Solution
You respect his wishes and agree to treat his symptoms only.
This is the real-life decision that urologist Joanna Chon
would make. "It's difficult because you see someone getting worse when
you think this person could have had a great outcome if they had chosen surgery.
Instead, you have to help him or her along with situations that arise because
that person still has urological problems that come up. It's hard to
watch, but patients have to make their own decisions."
Mr. Clark is asking you to ignore many signs that he probably has testicular
cancer and just treat his symptoms with medicine, instead of conducting surgery
to remove the testicle that may contain the cancerous tissue.
You have clearly laid out all the options to Mr. Clark and even spoken
with his friends and family. They all support his decision not to have surgery.
It is possible that he does not have cancer.
For a while, Mr. Clark seems to be doing OK. He is working hard at treating
his body right. After one month, however, his urinary tract complications
seem to be getting worse, and he starts coughing a lot and coughing up blood-tinged
sputum. Still he doesn't want to go under the knife. He believes that
nature must take its course.
You treat him as best you can. It is very difficult to watch what you believe
is the progression of the cancer to other parts of Mr. Clark's body.
But you are his doctor and must continue to treat him in the way that he wants.
You treat his urological problems medically and say goodbye to Mr. Clark before
his trip.
Unfortunately, the cancer seems to be speeding up and it is clear that
without radical action -- surgery, radiation therapy, chemotherapy and possibly
a bone marrow transplant -- Mr. Clark won't last more than six months.
When you explain this to Mr. Clark, he remains steadfast in his decision to
not be aggressive in his treatment.
Mr. Clark eventually dies and you know you did all that you could for him.
But it is not something you like to think back on.