The medical and ethical principle of self-determination allows a sick person the choice to forego treatment. This is the case for 41-year-old Ben, who has stage IV small cell lung cancer. There are numerous reasons that could have led to this decision. These reasons can be broadly categorized as costs, cultural, and personal factors. In particular, Ben lives in a rural community in Australia. He is probably a Native Australian, broadly referred to as Aboriginal and Torres Strait Islander (simply Aboriginal henceforth). When analyzing the factors that could have led Ben to forfeit treatment, it is essential to consider his situation within the context of his heritage, culture, and spirituality. The second part of this essay deals with supportive services that can be provided to Ben. This paper discusses possible reasons why Ben, a Native Australian with lung cancer, refused treatment and the possible services available for him at his rural home.
Decision to Forego Treatment
Ben’s decision to forego treatment for his lung cancer can be attributed to several factors. The first group of factors relates to the cost of care. The cost of healthcare in Australia is relatively high as compared to other countries such as Canada, Sweden, and Switzerland (Callander et al., 2018). Although the country has a national universal healthcare program, some of the cost is passed to patients. This out-of-pocket cost can discourage some people from seeking or undergoing treatment. Specifically, the out-of-pocket cost of treating chronic diseases is high (Callander et al., 2018). Ben could have foregone chemotherapy because it is unaffordable to him. In addition, the cost of accessing care for Ben could be higher because he has to travel to a facility far from his home. Transport, travel, and accommodation costs could add to the cost of care and surge it even higher (Sav et al., 2017). Therefore, the overall cost of care could have been a factor that led to Ben refusing treatment.
Aside from for monetary costs, Ben could have chosen to forego treatment because of all the work needed on his part, that is, nonfinancial costs. The work that patients need to do to treat or manage chronic diseases is known as treatment burden. Examples include managing medications, undertaking laboratory tests, completing paper work, and modifying lifestyle behaviors (Sav et al., 2017). In Ben’s case, he would be required to quit smoking. Given that Ben describes smoking as part of his culture, he may be reluctant to change this lifestyle behavior. He would also be required to visit the hospital regularly for his rounds of chemotherapy. In general, the treatment burden can be overwhelming and could have influenced Ben’s decision to not undergo treatment.
Ben might have also foregone treatment due to cultural factors. One cultural factor could be that Ben does not trust the modern healthcare system. Some Aboriginal people prefer traditional treatment methods over the “white man’s medicine” (Dunn et al., 2017). This distrust is well-founded since in the past, white people have done numerous atrocities against Aboriginal people including taking away their children and land and colonizing them (Sherwood, 2013). It is expected that some Aboriginal people still harbor some mistrust of white people and their medicine. Another cultural factor is cultural insensitivity displayed by medical professionals towards Aboriginal people. Many healthcare providers do not incorporate cultural awareness while dispensing care. Some Aboriginal people report receiving treatment marked by racism and rudeness from non-Aboriginal health staff (Sherwood, 2013; Lyford et al., 2018). This could deter people such as Ben who need care from undergoing a treatment. A final cultural factor is being away from family and community. Familial and non-familial relationships are a fundamental aspect of the Aboriginal culture (Thompson et al., 2011). People live in close kinship with each other, and life is generally communal. Ben could have chosen to forego treatment because it would involve being away from his family and rural community.
Ben may also have chosen to opt out of treatment for personal reasons. He could be pessimistic about his chances of survival. Some cancer patients, especially those in the late stages, forego treatment because they believe they will die whether they get treatment or not (Dunn et al., 2017). Therapeutic nihilism is a reason that could have contributed to Ben’s decision. Another personal reason is that Ben could be upholding beliefs about stoicism and masculinity. It is common for men to forego treatment because they believe they are expected to be “strong”, especially for their families. If Ben holds these beliefs, they could make him fail to undertake treatment. Finally, Ben could believe that chemotherapy will cause him more pain than good (Sav et al., 2017). He could be afraid of the physical toll that the treatment would take on his body, leaving him weaker than he would have been without treatment. Such personal factors may have contributed to Ben’s decision to forego treatment.
After choosing to forego treatment, Ben would need supportive services when he returns to his rural community. The first category of support services is provided by family and community. Among Aboriginal people, being surrounded by loved ones is an important aspect of culture. People belong to a given family or group by virtue of birth, shared language, or cultural obligations (Gee et al., 2014). Aboriginal people hold the view that life is meant to be lived communally (Thompson et al., 2011). This includes caring for and supporting the sick in whatever capacity they need. The community would provide social and emotional support for Ben as he deals with untreated lung cancer. In addition, his family would physically care for him as the illness progresses. The family members would help him perform activities of daily living when he is no longer able to do them himself. Ben needs the care and support of his family and community after choosing to forfeit lung cancer treatment.
Ben might also need the help of a mental health professional. Chronic diseases are often accompanied by mental health illnesses such as depression and anxiety (Bernardes et al, 2021). While his family and community can provide some emotional support, Ben might still need to see a mental health professional such as a counselor. The healthcare provider would help him navigate living with cancer for which he is not receiving any medication. The person should provide culturally-sensitive care for Ben to be comfortable with them. For instance, they should know how Ben’s heritage as a Native Australian would affect his mental health. Aboriginal people reportedly experience psychological distress at a rate of two and a half times the rate of other people (Gee et al., 2014). The counselor should also know how to integrate aspects of Ben’s spirituality into his treatment. Most Aboriginal people are spiritual, and it essential to incorporate spirituality in treating any mental health issues. Finally, although not compulsory, the ideal counselor would also be am Aboriginal person (Fried, 2021). This is becausee Ben could be distrustful of people from the dominant cultures.
Another supportive service that Ben would benefit from is palliative care. Palliative care is care meant to meet the physical, social, emotional, and spiritual needs of people with chronic diseases (CareSearch, n.d.). It also involves providing end-of-life care to those who need it. Ben would need palliative care as he combats lung cancer in its fourth stage. According to Lung Foundation Australia, when large cancer masses invade the lung, they cause pain and breathing problems (Lung Foundation Australia, n.d.). Although Ben is not interested in receiving chemotherapy, he could still receive medication for the pain. This could be drugs from western medicine or other pain treatment options available in the Aboriginal culture. Ben should be allowed to decide his preferred treatment option. Self-determination is an important aspect of providing palliative care.
Aside from pain management, palliative care can provide emotional and spiritual support. It is essential to have support from multiple sources while managing a chronic illness such as lung cancer. Additionally, palliative care can be extended to Ben’s caregivers. Providing care to a person with a chronic illness can be taxing on the caregivers (Bernardes et al., 2021). It is easy for them to feel depleted and inadequate in taking care of the sick. Ben’s caregivers, primarily his family, can also receive advice and support from a palliative care center. This would enable the family members to look after him better. It is important to note that Ben can receive palliate care at home or within a facility close to his home. This would enable him to remain close to his family and community. Ultimately, the goal of palliative care is to maintain or improve a person’s quality of life.
In summary, Ben could have decided to forego treatment for various reasons. The out-of-pocket cost of healthcare in Australia is high, which could have influenced his decision. The burden of treatment for lung cancer is also high. The treatment would require him to quit smoking and take better care of himself. This might have made him hesitant to undergo chemotherapy. Aside from material and non-material costs, there are elements of culture that could have dissuaded Ben from undergoing treatment. Examples include mistrust of western medicine, the need to be close to his family, and the fear of mistreatment by medical staff. Ben could also have personal reasons for forfeiting treatment. Upon returning home, he will need supportive services from his family and community. He would also need the help of a mental health counselor to combat mental health issues such as anxiety that usually occur alongside chronic disease. Finally, palliative care may be necessary as Ben could be approaching the end of his life.
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