During my heme onc rotation, I had a patient with Hodgkin’s lymphoma who arrived to the ED feeling faint. She had a hemoglobin of 3.4, likely chronic from her malignancy. Apparently, she had been diagnosed with Hodgkin’s lymphoma a year ago, and had refused treatment and had opted to take herbal remedies instead. This was done to be consistent with her beliefs, she and her husband described themselves as naturalists and Muslim. During her hospital course here, she developed a life-threatening emergency: HLH.
Before developing HLH, we told her and her family that Hodgkin’s lymphoma is a treatable cancer, with many achieving success despite being advanced staged (we staged her to be Stage IV). We stressed that her symptomatology was most likely related to her untreated cancer. Unfortunately, we were met with a resistance to undergo chemotherapy. The husband cited that life was in the hand of the creator and that he worked at a nuclear plant and worried about giving radiation to his wife (the patient). She also expressed hesitation in undergoing treatment. Her daughter, however, was adamant that her mother receive chemotherapy. After days of talking, we finally convinced the patient to take etoposide for the HLH and undergo a round of chemotherapy in the hospital–which she did. Unfortunately, she went septic and passed away a week later.
To me, this highlighted a battle between autonomy and beneficence. We have potentially life-saving treatments that patients refuse for whatever reason. The refusal can be frustrating, but it is important to realize that it is the patient’s RIGHT to refuse or to accept any treatment. The most frustrating aspect of this case for me was how people, despite presenting the mountains of evidence for therapy, still are not convinced and actively opt into treatments that have ZERO evidence of benefit. I feel strongly that, as physicians, we should be blunt and honest about this. If something does not work or has not been studied, we should present it as so!