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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 362

Breaking bad news and autonomy of cancer patients


Department of Medical Oncology, University College London Hospitals NHS Foundation Trust; Department of Medical Oncology, Princess Alexandra Hospital, Harlow, London, England, UK

Date of Submission07-Apr-2020
Date of Decision10-Apr-2020
Date of Acceptance29-Apr-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Apostolos Konstantis
University College London Hospitals NHS Foundation Trust, Euston Road 250, London NW1 2PG, England
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_127_20

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How to cite this article:
Konstantis A. Breaking bad news and autonomy of cancer patients. Cancer Res Stat Treat 2020;3:362

How to cite this URL:
Konstantis A. Breaking bad news and autonomy of cancer patients. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 5];3:362. Available from: http://www.crstonline.com/text.asp?2020/3/2/362/287204



The article by Chandrasekharan [1] on two cases of breaking bad news in cancer patients in India raises some of the most significant objectives of bioethics such as truth-telling and patient autonomy.

Respecting patients' autonomy involves the full disclosure of information, as they can make choices about their care only if they are fully informed about the diagnosis, prognosis, and treatment options. It is then the patient's ethical values, not the physician's nor the family values, that should control medical treatment.[2] Patients who are well informed about their medical condition and intent of treatment are more compliant and have realistic expectations. In the case of a dishonest relationship and practices in breaking bad news, patients will be less likely to trust the physicians and their reassurances.[3]

Often patient's autonomy and the right to full disclosure of information conflicts with the idea of many cultures that bad news should not be given directly to patients but to families, who should regulate and control medical information or treatment options.[4],[5] On these occasions, two intertwined moral values compete with the physician's obligation to respect patient autonomy: the duty to respect the needs of families and the responsibility to regard the diversity of cultural positions.[2]

It is imperative to consider patients' autonomy, not as a simplistic notion but an abstract concept that exists or not, and better understand what the patient truly wants to know and how to respect their choices.[2] Some patients may opt for their families to make decisions or waive their right to be informed about their disease. We must encourage patients to communicate their wishes and respect the diversity of ways in which patients choose to exercise autonomy rather than rushing to implement a western model, especially in countries unfamiliar with the concepts. An approach like that does not represent an attempt to ignore a patient's wishes.

Another step could involve family meetings for a better understanding of the human beings behind the family members and the patient, their wishes, and the dynamics and explore further the concept of truth-telling and its benefits. Patients' autonomy is rooted in a variety of family and cultural contexts, and their exploration and respect are the primary steps in order to improve the current situation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandrasekharan A. A tale of two patients. Cancer Res Stat Treat 2020;3:1-2.  Back to cited text no. 1
  [Full text]  
2.
Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting patient autonomy: The importance of clinician-patient relationships. J Gen intern Med 2010;25:741-5.  Back to cited text no. 2
    
3.
Baumgarten E. The concept of patient autonomy. Med Updates 1999;2.  Back to cited text no. 3
    
4.
Konstantis A, Exiara T. Breaking bad news in cancer patients. Indian J Palliat Care 2015;21:35.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Konstantis A, Exiara T. Family caregiver beliefs and barriers to effective pain management of cancer patients in home care settings. J BUON 2018;23:144-52.  Back to cited text no. 5
    




 

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