Fertile Hope

In my last post, I said that knowledge helps patients deal with losses such as infertility. Here's an example:

If young patients who are newly diagnosed with cancer don't find out about their risk of infertility, they may be devastated by the discovery when they try to start a family. Even if they would make the same treatment choice had they known about the risk to fertility, they may still find it difficult to accept their infertility because of their sense they didn't choose it.

And for young patients who don't learn about options for preserving fertility after learning their chosen treatment will make them sterile, forever after they may regret losing their window of opportunity for preserving their fertility.

Knowledge helps these young patients become Healthy Survivors. For example, "Fertile Hope is a national, nonprofit organization dedicated to providing reproductive information, support and hope to cancer patients and survivors whose medical treatments present the risk of infertility."

Fertile Hope recently released the first online fertility options calculator. This way, patients can find out their options quickly and easily before proceeding with cancer treatments.

Knowledge is power.

Comments

[B]

I understand and completely agree with the importance of patients having knowledge when making treatment decisions. But, what if the fact that one will never be able to jump/run again or that one could possibly be sterile keeps them from making a knowledge-based decision? Instead a young or emotionally-driven patient, who would have chosen the life saving treatment cannot come to make a decision that possibly makes them sterile. Whether religious-based, emotional or more immature their decision cannot be effectively made with full knowledge. In an effort to help patients make wise life-saving decision, is it possible there is a time for full disclosure and also a time to keep some adverse effects aside (since they are only risks and not certainties) ?

[Wendy S. Harpham, MD]

Assuming we are talking about an adult patient (over 18 years old) who is not clinicially depressed or suicidal, you are asking if it is ethical for a physician to intentionally leave out certain key facts in order to sway the patient toward what the physician knows gives the patient the best - and maybe the only - chance at survival.

No. Lying by omission is still lying, misleading the patient, and causing a patient to make a decision they wouldn't have made with all the facts. In this day and age, patients have the right of autonomy. Ultimately, the patient chooses what he or she does.

In the interest of quality care and Healthy Survivorship, physicians have many tools at their disposal to guide such patients toward life-saving or limb-saving treatments.

As indicated, the physician should evaluate for any mental illness that might be making the patient incompetent.

The facts can be presented in hopeful, encouraging terms. For example, to say, "60% of patients end up sterile" sounds very different than saying, "A full 40% of patients retain their fertility."

In addition, the physician can bring in family who might be able to support the patient through the decision-making. The physician also can involve other health professionals, such as social workers, clergy or counselors, who can address the patients' fears (such as fear of being seen as 'damaged goods.')

In the end, it is always the patient's decision.

Thanks for your question. With hope, Wendy

[Deb]

Difficult questions raised, harder answers.