Therapies for Incurable Cancers: Halachic Aspects
Frank Lieberman, MD, Professor of Neurology and Medical Oncology, University of Pittsburgh Hillman Cancer Center; Melissa Burgess; Assistant Professor of Medicine, University of Pittsburgh Hillman Cancer Center; and Daniel Schoen, Associate Rosh Kollel, Kollel Jewish Learning Center of Pittsburgh
The treatment of patients with cancer diagnoses in which survival is anticipated to be short requires the patients, their families, and the oncologists guiding therapy to confront difficult and complex questions about the level of risk patients should assume, the role of investigational therapies, quality of life and the impact of toxicities of therapy, and the appropriate time for transition to hospice an palliative care.
We present a case study illustrating how a patient diagnosed with undifferentiated brain sarcoma with subsequent systemic metastases made decisions involving surgeries, investigational therapies, and subsequent treatment with chemotherapeutic regimens which led to survival for a period exceeding the expectations of her physicians.
This case illustrates the halachic definitions of prolonged versus short term survival relevant to assessing the level of risk of individual therapeutic options, relevant risk categories for standard and experimental therapies, criteria for consent for experimental therapies, guidelines for consideration of quality of life, and the different degrees of discretion in decision making assigned to the patient herself versus surrogate decision makers.
This case also demonstrates the humility required on the part of physicians caring for and prognosticating outcomes for patients with incurable cancer.
We present a case study illustrating how a patient diagnosed with undifferentiated brain sarcoma with subsequent systemic metastases made decisions involving surgeries, investigational therapies, and subsequent treatment with chemotherapeutic regimens which led to survival for a period exceeding the expectations of her physicians.
This case illustrates the halachic definitions of prolonged versus short term survival relevant to assessing the level of risk of individual therapeutic options, relevant risk categories for standard and experimental therapies, criteria for consent for experimental therapies, guidelines for consideration of quality of life, and the different degrees of discretion in decision making assigned to the patient herself versus surrogate decision makers.
This case also demonstrates the humility required on the part of physicians caring for and prognosticating outcomes for patients with incurable cancer.