Decisions, decisions, decisions

Al-Noor Nenshi Nathoo, executive director of Provincial Health Ethics Network (PHEN), offers some examples of complicated issues that may come up for patients, families, health-care providers, cancer treatment centres or cancer prevention programs:

  • When a child has cancer, and the treatment has a low chance of success and generates significant side-effects or suffering and pain, when, if ever, is it appropriate to stop treatment and “let nature take its course”?
  • What is the moral difference between euthanasia and withholding treatment?
  • When a patient has not expressed wishes about his or her care and can no longer do so, and a patient’s family and their physician disagree over what treatment should be provided, whose opinion should hold power?
  • When patients cannot speak for himself because he does not have decision-making capacity (either because of a developmental disability, mental illness resulting in a cognitive difficulty, or is a young minor), who should make decisions for him? If the health-care team disagrees with that decision, what should they do, if anything?
  • If a particular cancer drug has been approved for use in Canada but the cost is not covered by the provincial health system, is it OK for a cancer treatment centre to administer the drug if the patient pays for it?
  • If one of the principles of health care in Canada is equitable access, how far should the system go in providing cancer care, close to the residence of citizens, who live in rural areas?

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