Cancer Patient’s Autonomy and Medical Ethics

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Introduction

In contemporary society, the patients’ autonomy is widely acknowledged. The autonomy in cancer patients is vulnerable, which has made it an important aspect of medical ethics. The patient’s autonomy is concerned with facilitating patients to make independent decisions regarding intervention measures. However, there are some drawbacks concerning the respect for patient’s autonomy and at some point, relational understanding between patients, clinicians, and social relations offers meaningful insights for patients well being. Social relationships describe ways in which interactions with cancer patients can bear positive or negative feedback.

Background

Cancer can be defined as unnatural growth of cells, which tend to multiply abnormally and spread. Cancer is a combination of many viruses with Ribonucleic acid (RNA) coding and regulating their genetic information (Pulverer et al. 335). Research by Pulverer et al. indicates that cancer is highly associated with the genetic composition, infectious components, and environmental factors (335). Infectious agents may include eating habits while environmental influences include industrial waste releases among others. Patients with cancer go through an array of emotional and social challenges due to the diagnosis and intervention related implications. The psychological implications of cancer are huge, and each patient’s life may be interfered with, in all aspects of life such as role, financial status, family role, and networking (Armaiz-Pena 13).

Unlike the past, the focus on patients’ autonomy has been overemphasized causing confusion between the medical ethics discourse and the human rights discourse. The two areas partially overlap making it hard for clinicians to determine the right cause to take. The Western countries have been criticized by their Eastern counterparts on the move to attach their individualistic notion to patient autonomy. With the rise of the field of bioethics, the construal of patient autonomy has sparked a discussion that differs from leftists’ values about human rights discourse.

The proponents of the human rights discourse argue that the Western notion of the patient as a fully conscious being, rational and capable of making choices on diagnosis options offered, is lacking on the basis that humans also act irrationally. However, there is the need to distinguish between the right of access to treatment and the respect of autonomy to reject treatment. This distinction will shed light on the matter and possibly lead to consideration of the relational autonomy when the patient is willing to get advice (Cheng et al. 246).

While many people respect health as a human right, it is much complicated to understand what that translates to clinicians. The clinicians are expected by the law to provide the best care possible to their patients. Part of this care involves recommending the appropriate health care approaches for patients. Adhering to the standards of human rights charter to some extent parallels the bioethics expectations to grant patients the total freedom to make decisions independently. In this impasse, the conflicts arising between patients and clinicians highly impact on the well-being of the patient.

While acknowledging that human rights are universal in nature, they must be viewed from a perspective of a changing process of the global norm-setting. In other words, the principle of respect for autonomy should be tolerated, and only changes should be made towards reinforcing the capability of the patient to remain independent. Therefore, this essay seeks to support the claim that getting involved in a social environment has a tremendous impact on cancer patients regarding their well-being. The rationale behind this claim is that mental effects increase from not engaging cancer patients with the public as well as neglecting their autonomy.

Respect for autonomy

The topic concerning respect for patient’s autonomy has been a longstanding debate on the issue of cancer. Recently, the debate seems to focus on circumstances in which call for decisions regarding treatment options. Respect for autonomy is also considered when clarifying issues about confidentiality, honesty, and integrity. In essence, autonomy is highly linked to the idea that patients should be given the opportunity to make a choice about their diagnosis. According to Cheng et al., mental effects emerge from neglecting the decision of cancer patients (245). Compelling patients to act against their will induces stress. The patient starts to feel that s/he is not protected but being exposed to frightening experiences. This discomfort facilitates tumor growth and cell proliferation.

Relatively, informed criticism has been made regarding this construal of obsolete freedom of choice. Relational decision making or rather informed decision is viewed as a more sober option given that respect for autonomy requires practitioners to inform the patients about their diagnosis choices then leave them to select. Respect for autonomy wards off some unwanted interventions from family or friends. For instance, allowing patients to avoid procedures that they consider more psychologically damaging than healing.

For instance, some patients prefer not going through chemotherapy and lose their hair, weight, and skin color. Respect for patients’ autonomy is also viewed as a means to save time and start treatment. Consultations between the patient, family, and clinicians are seen as time-consuming. According to a study by Cheng et al., about 77% of the 52 participants interviewed indicated that their autonomy was respected to the extent they wanted, but the majority of the remaining 23% felt that they did not make a proper impact in decision making concerning their treatment (249).

Allowing patients to make independent decisions also improves their understanding of cancer treatment options and procedures (Reid 472). This approach creates confidence, self-control, and determination to fight the disease. However, if practitioners are more obliged to enable and permit choice than to guide individuals to make helpful choices, the construal of autonomy may fail to impact the incompetent patients. Besides, they are also a group of competent patients who are not confident enough to select between various medication options. This group of individuals exhibit conflicting priorities and may end up blaming themselves if results are underwhelming. Consequently, these patients generate a sense of abandonment and never see the sense of autonomy if their caregivers fail to act beyond informing them about choices and leave them to select. Currently, a new discourse on relational the understanding of autonomy has emerged to clear the stalemate regarding the principle of respect for autonomy.

Relational accounts of autonomy respect the fact that patients should be encouraged to make own decisions. This discourse also reckons the pervasiveness linked to societal influences such as undermining independence. It also recognizes the conflicts that might thrive if family members and clinicians are given the green light to choose treatment options for cancer patients. Nonetheless, relational autonomy should be viewed as encouraging interdependence and seeking to support the patient’s ability to make own decisions. This discourse insists that the patient’s capability to make own decisions is socially molded (Reid 473).

Relational aspects motivate practitioners to consider that cancer itself impairs patients’ autonomy by preventing personal cognition skills and undermine self-evaluations. This aspect is also a relief to the clinicians who find it hard to share their informed concerns if their patients select a weak diagnosis. In some cases, the family mounts pressure on the cancer patient to adapt a diagnosis that does not match their wish. In this case, clinicians are at the favorite position to bring consensus for patient’s autonomy. This case is risky and can affect the patient negatively. Failure to respect patients’ autonomy can cause mental problems or make the recovery difficult even when the procedure is proven.

Successful cancer patients are more outgoing, aggressive and like socializing with the public, as it is helpful for their way to recovery. Studies have provided overwhelming evidence relating to chronic stress, mental instability, and social negligence in the cancer recovery process (Moreno-Smith, Lutgendorf, and Sood 1867).

Special situations call for professional skills. Not anybody can be worth talking to cancer patients who are at a point of despair. Some talks about cancer by less informed people inflict pain rather than offering solutions. When seeking advice, it is necessary to consult cancer care teams for referrals to a reputable counselor. This aspect is meant to improve the chances of getting a counselor who has respect for patients’ autonomy. Such counselors should manifest their prowess to indulge interdependence in decision-making. This assistance is referred to as social support. Social support is seen as the patient’s ability to reciprocate after perceived satisfaction from social engagements (Wold 122). These support increases hope thus cushioning psychological stress responses. Social support can also promote a patient’s capacity to make independent decisions. Social aspects shape people’s capability to make informed decisions. Ultimately, relational accounts facilitate communication with patients towards all positive implications for their autonomy.

Counter argument

Many factors aggregate to successful recovery among cancer patients. However, living in a social surrounding, where respect for patients’ autonomy is prioritized cannot be viewed as the main projector of success to recovery. The impact of the social environment is not unique to cancer patients since normal people also benefit from such settings. Therefore, it is not about feeling protected or recognized, but the urge to fight against all odds. To some extent, these social environments may offer negative impacts when patients are overprotected in the process of offering support. Furthermore, not all social settings are pleasant for cancer patients. Some people who talk about cancer menace have little information and might instead harm the patients unknowingly. Thus, it is upon the patient to act decisively, set goals, and seek ways to accomplish these goals despite what the social settings have to offer. When patients have no passion to fight, it is hard to recover no matter social support. When the will to fight is present, social support and other factors are secondary but essential.

Possible ways of fighting cancer

According to Erer, Atici, and Erdemir, there are three primary ways of treating cancer (385). However, research is ongoing to establish the credibility of other upcoming procedures such as tumor treating discourse, where low-intensity electric fields are used to kill cancerous cells. The three main processes include radiation, chemotherapy, and surgery. These procedures aim at destroying the cancerous cells through radioactive rays. Every stage of cancer cells for a specific plan of treatment that has to be addressed mutually by the clinician and the patient. Various food components such as vitamin D have been determined through research to play a major role in cancer prevention (Garland 255).

Patients acknowledge the care they receive from their health care teams, but many who do well take an active role in fighting with their condition. Since clinical procedures alone are not adequate to fight cancer, they are various coping techniques that patients adapt. For instance, regardless of health status, every individual should have people around him/her who can give a helping hand when the need arises. For cancer patients, it is advisable to find someone who brings comfort talking to about the illness. When not in the company of such people, listening to music can help provide a calming environment. With time, cancer patients come to realize what works for them. In case nothing has worked in the past, it is essential to seek a different way to cope (Kim et al. 307).

Handling cancer stepwise helps make it easier to manage and allows patients to target on getting the best out of every day. It is good to leave worries about the past behind, forget about the future and deal with the situation day wise. This approach makes the task of adjusting to appear less demanding. Cancer patients should focus on working with doctors whom they feel comfortable within the process. It is necessary to build a feeling of mutual respect and honesty. Let the doctor be a partner in the treatment process. Patients should feel free to ask questions to know what to expect and how to prepare. Keeping personal records of general treatment progress is helpful to help measure how near or far one is towards their goals (Moreno-Smith, Lutgendorf, and Sood 1871).

Contrary, they are things that cancer patients should avoid. Some beliefs associated with cancer are misleading and uninformed. For example, the belief that cancer is a killer disease (Wold 120). Studies indicate that in the United States alone, more than 14 million people have survived cancer. This evidence should motivate cancer patients to fight their way to recovery. Cancer patients should restrict from blaming anyone for getting the disease. Despite the fact that one might have raised their cancer risk via eating habits or smoking, the blame game can only complicate the situation.

Some patients prefer not to involve other people and choose to suffer in silence. Trying to get through alone derails the recovery. Being in the company of friends, family, or colleagues at the support groups has a great impact on the recovery process. Cancer patients should always consider having a friend along when visiting their doctors and talk about the treatment. In most cases, cancer patients who are anxious rarely absorb information thus a friend can help interpret what was advised on a later date.

Emotional effects among cancer patients

No matter how significant development has been established in treating cancer, people get upset when diagnosed with cancer. Every aspect of cancer is painful and stressful, for example, dealing with the adverse effects of the diagnosis. Besides, many issues are unanswered about cancer. This uncertainty makes people worry about what may happen in their life when they realize they have cancer. For example, the major fear for patients of cancer is death. Even though millions of people are still alive despite having cancer and other have beaten it, the stress of having cancer remains imminent. Cancer patients are concerned with the coping mechanism of their family and friends and the ensuing events. Once an individual learns s/he has cancer, they start feeling weak, vulnerable, unlucky, and frightened. Their normal life drastically changes, and this affects them psychologically. The feeling of being vulnerable affects cancer patients to an extent of getting emotional and anxious about nearly every aspect.

Undoubtedly, patients of cancer often report being in a dilemma and out of control. Unlike normal people, cancer patients at times feel ashamed yet it is situation beyond their control. These patients find it hard speaking about their situations since they perceive it as a burden to others. Furthermore, the fact that they are diagnosed with cancer gives them a perception that they are about to die thus giving up in life is not a big deal. It is evident that cancer is a frightening disease, and that it is among the leading causes of death in the world, but many people have fought and recovered.

Response to these emotions

A certain level of distress is natural when an individual realizes s/he has cancer. It is natural to worry and have fears because of the uncertainties associated with cancer. Therefore, respect for patients’ autonomy remains essential to avoid more stress if a patient is diagnosed against his or her will. Some patients cannot tolerate the side effects of treatment, and thus they may feel pressured to a point of committing suicide. Kim et al., indicate that 65% of physicians interviewed in their study claimed that they had found respecting some of patients decisions hard since they were against the work ethics (310).

For instance, 12% of the patients had requested the physicians to turn off life support machines. Only 1% of the respondents agreed to turn off the machine (Kim et al. 310). The rest argued that they would agree with the request s if such an action was allowed. Some will even choose suicide than going through treatment while others will feel greater distress after undergoing treatment. Residual fears concerning recurrence keep ringing on patients mind whenever they experience mild aches. Even after treatment, cancer patients live a life of waiting to see what happens next. This feeling continues to instill emotional influences on some patient’s thus slowing or even preventing diagnosis.

Other people remain strong and seek support system to assist them to move on with their usual life. Even though it is hard to recover psychologically and physically, some patients show positive remarks and desire to be an inspiration to others. At times, they find it hard to control their emotions, and they seek assistance from counselors and move on with life. Even after recovery, it is normal to experience low periods, encounter new challenges, and diseases. This aspect does not imply that cancer is recurring thus no need to worry.

The impact of psychologists on cancer patients

Currently, the evidence is mounting to support the claim that psychological therapies promote emotional well-being and minimize treatment fears and recur-related distress. Different patients react differently to services provided by psychologists and depending on their levels of distress. However, patients who seek relational counts for autonomy find people who can help them decide which services can best suit them. A social worker, for instance, can help patients realize what kind of psychological problems they are undergoing. For instance, difficulties adjusting to treatment, trouble with treatment options, social isolation, end of life concerns, or lack of caregiver support. Learning through a psychologist has been seen as a genuine way for cancer patients to adjust positively towards recovery. During counseling, psychologists provide patients with models to help them resolve the challenges in a manner that matches their conditions. Patients get to learn how to accept and adapt to their new condition towards recovery (Kim et al. 303).

In case the patient is experiencing practical problems such as family abuse or lack of social amenities, the psychologist can suggest a community agency to house and offer group sessions. This social support ensures continuity of care for cancer patients. However, addressing psychosocial needs for some patients may vary and result in negative implications when the respect for autonomy is undermined. In some rare cases, some patients consider not talk about their condition and instead stay quiet hoping for the best. These patients find it therapeutic walking in the parks alone and hanging in other quiet zones. According to Kim et al., out of 192 patients involved in their study approximately 65% of them preferred using other sources of information rather than from their doctors to gain insight about their condition (304). This move was observed as the patients’ strategy to gain information and stand a better chance to make own decisions, and thus they expected their decisions to be respected. About 6% reported to have sought the information from internet, 37% from medical books, 40% from other patients and 10% used radio and television.

The impact of motivating patients

Emotional and social support should be always directed to patients with cancer. Cheering up a patient during psycho-educational activities reduces tension and depression. These programs also increase knowledge to understand one’s condition together with how to adjust. Perceived negligence and isolation from the society may increase depression (Wold 118). Patient’s improvement to living with cancer can be facilitated by the support of the friends and family. On the other hand, criticism and overprotection by the society generate stress and gloom mood.

Therefore, families and caregivers should seek training from professionals to learn how to manage appropriate communication with cancer patients. Appropriate advice from a friend or family boosts the well-being of cancer patients. The chance to talk about feelings and progress with a well-informed friend or family member minimizes psychosocial distress. Good interrelationship nurtures confidence and builds hope for a brighter tomorrow. This feeling also improves the capability of a patient to make informed decisions regarding treatment and lifetime goals. Being part of peer activities is helpful for patients who may have an isolated past (Lutgendorf, Sood, and Antoni 4095).

The impact of green environment

Current research has linked the natural environment as having health benefits for patients with cancer. Increased connection to nature can enormously relieve stress by diverting thoughts to the serene surroundings (Kim et al. 302). Green environments are viewed to possess the charm to relieve fear, provide hope, and introduce pleasant feelings. These friendly and calming sensations offer positive diversions from environmental and mental stressors.

Overcoming cancer

The contemporary society is full of possibilities when there is the determination to act. Many cancer patients have come out publicly to disown their cancer-infected life after a successful recovery. Even with medical examinations, critiques still do not agree cancer is curable. They only believe those are assertions of individuals who purport to have fought the inevitable and come out to compete with other people. Since normal people will rarely agree on a challenge from individuals coming from a disadvantaged situation, the issue of recovery will remain a debate for the foreseeable future. Wold suggests that most cancer survivors believe that failure to fight the illness derails the recovery process (117). However, the personal belief and strength to fight emanates from social settings. Ignoring cancer patients builds the idea of despair.

Conclusion

The cancer patients’ autonomy is a fundamental aspect in several health care contexts. Patients’ autonomy encourages self-governance for health-related encounters. When patients are given the freedom to make their choices, they experience relief since they do not feel obliged to do what they do not want. However, it is necessary to find a balance between allowing and helping cancer patients to make choices. This balance is found in the social environments where patients can talk about their illness with friends and family. Being in such environments has a positive impact on cancer patients’ recovery. Interventions that aim at creating problem-solving approaches, coping ways, training, and stress relief have been found to be shaped by social environments.

As noted earlier, not all competent patients have the confidence to decide for themselves. Besides, some patients are incapacitated by the effects of cancer, making it necessary for clinicians to consider supporting patients’ autonomy. In this case, the aspect of relational accounts should be given consideration to facilitate the independence of cancer patients. Relational autonomy increases interdependence at the same time observing respect for autonomy. Focusing too much on patient independence may risk a feeling of isolation by patients who feel weak to make decisions on their own. Since social isolation is a primary factor that exacerbates the desire of dying, clinician and family should stay close as needed by the patient.

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