Cancer is a condition wherein an individuals life deteriorates.

As
defined by Smeltzer,S. et.al (2010), it is a disease process whereby cells
proliferate abnormally ,ignoring growth regulating signals in the
environment surrounding the cells. Nowadays, the rate of cancer is largely
increasing all over the world, attacking all ages and both men and women.
As thedisease percentage increases , discovery of the treatment such as
surgery, chemotherapy chemoradiation also increases as a part of curative
treatment also increases to help in improving the condition and prolong
the life of a patient diagnosed with cancer.
In the case of Michael , a 50 year old single, diagnosed with advanced
head and neck cancer. Over the last 2 years , he has had undergone
surgery, chemotherapy and radiotherapy as a part of his curat ive
treatment. As time goes by , his condition persisted. On his admission he
has developed dysphagia , dyspnea and is very weak, due to his dysphagia ,
he is unable to tolerate ingestion of food to maintain his nutrition that may
also aggravte more his weaknesss and possibly will lead to his death. This
condition now suggested that he needs to undergo ssurgery (gastrostomy )
to be able him to feed through PEG, but , unfortunately , micheal refused
the treatment gastrostomy for his feeding to commend and has stated that
he waants no further active treatment but oly to be looked after.
As part of multidisciplinary team taking care of him, seeing him in that
situation and knowing refuses to undrgo an active treatment to prolong his
life , it is crucial and causes burden to us. According Maslows Hierarchy of
need , under the physiologic needs , food or nutrition is one of the most and
basic needs that an indiviadual must meet . As he refuses , we as a prt of
the multidisciplinary team , we felt that we failed on our duties, obligations
and responsibilities in taking care of him , in gicing the best the quality
care to prolong his life. On the other hand we also have a role as a nurse in
his condition and decision and that is to become a patient advocate to him ,
that made our decision to stand as partially agree that we must follow and
support his decision with regard to the active treatments that he wanted
or nor wanted to receive as a part of his living will. In caring a patient
(michael ) , we should include and collaborate wwith him in deciding as to
what are the treatments that he wanted to receive as we do our part and
that is explaining what is the treatment for , the benefits , risk and its
consequence upon diagreeing not to undergo that treatment that would
guide him in making ssuch decision for his condition. According to patients
bill of rights, a patient has the right to refuse drugs, treatment, or

procedure offered by the hospital, to the extent permitted by law, and a

physician shall inform the patient of the medical consequences of the
patients refusal of drugs, treatment or procedure. As he decides on what
ought to be received and not ought to be received, no matter what it is we
should follow and support it. We should highly respect hisright in self
determination , his autonomy and right to refuse. Respecting such decision
made by Michael facilitates his liberty in making decision and personal
authority in the treatments that was suggested to him. As a nurse
respecting his autonomy is acknowledging his choice for his own personal
belief and values. Another journal by Thorns, A. et.al. (2010), respecting
autonomy does not equate to choice. To explain all the implications of such
a decision, ensuring the patient has capacity and has appreciated all the
important consequences, demonstrates respect for autonomy. As the
principle of non-maleficence, by respecting the patients decision, we are
also avoiding harm to the patient by not giving unwanted treatment .
(Mohanti, K. 2009). According to Kant (1724-1804) , the principles of
deontological ethics considers that we as a nurse of Michael should
respect him and do what is right for the patient basing on his decision
regardless of the consequence
(consequentialism )afterwards. Yes, this is the most crucial part for us
nurses involve in taking care of him , the acceptance of his choice , because
what we want for him is what we think is the one that would be
beneficial(beneficence) for him while the he wants otherwise If we are
going to contradict his decision , this would further cause him more harm
and distress and we dont want to add more distress and burden as well as
bypassing his right for autonomy by contradicting his decision for his active
treatment. In supporting his decision felt like we are participating in
initiating euthanasia. According to Manolo et.al. (2010), in such cases, it
should be clarified that in accordance with the Vatican Declaration on
Euthanasia, when inevitable death is imminent, it is permitted, with the
patients consent, to refuse forms of treatment that would only secure a
precarious and burdensome prolongation of life, and to interrupt means
provided by the most advanced medical techniques where the results fall
short of expectations. It should be made clear that withholding or
withdrawing life-sustaining therapies that are disproportionate to the
expected outcome is not equivalent to euthanasia; it is in fact considered
ethical and medically appropriate, as long as basic humane, compassionate
care is not interrupted. But as a practitioner, our duty is to save life and
prolong life, the question is, when to stand if the patient decides to not
prolong his life. According to Norval, D. and Gwyther, E. (2003), Saving

lives will always remain a primary goal of clinical practice and the passion
to prolong life is responsible for the exceptional advances in medicine over
the past century.20 But when it does not take into account the fact that at
some point life cannot and should not be prolonged, it creates rather than
alleviates suffering. In medicine, we need to accept that dying is a natural
part of living. The doctrine of double effect as well as the consequentialism
goes along with the beneficence , as stated above, that what we think is
good for him but for the patient is not and vice versa. Because for him his
decision is worthwhile.
Gillon (1986) reminds us that the action cannot only be judge
ethically in terms of consequence but we should also consider the vital
aspect of Michael as a unique individual and his moral and personal values.
Although he refuses the active treatment for him, he still wishes to be
looked after and we should still attend to him and anticipate his needs until
his near death comes and through this we could give a quality of life that he
wanted and a dignified living until his end-of-life.

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Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA
30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDCINFO
Landrum, S.E. (2003). Patient;s Rights and Responsibilities. Journal of the
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