Discourse - Ethics and Decision-Making: Lessons from the Cancer Wars

Abstract

North Americans, when healthy, hold to the widespread belief that they would want to be involved in making decisions about their medical treatment if they were suddenly to be diagnosed with a life-threatening illness. This belief is conditioned by the prevailing culture of "take control," which emphasizes the role of the individual in determining his or her own fate. The belief is perhaps most developed in the United States, where the purchase of health-care services is possible and where, by purchasing the "best" services, you could think you might actually be able to dodge the bullet of disease and disability. The need to believe that one actually has a degree of control over health-related events is deeply rooted and implies that one's survival may in fact be determined by the strength of character and resilience one demonstrates in the face of catastrophic events. Nowhere are these beliefs better illustrated than in the "cancer wars." In 1970 President Nixon declared War on Cancer. I remember being a young graduate student at the University of Washington in Seattle when this announcement was made, to much excitement across the United States. Those of us studying in the field of cancer nursing shared this excitement, perhaps naively. While the past three decades have seen impressive gains through reduction of disease morbidity and mortality in certain types of cancers, most notably and thankfully in those that strike children and young adults, it is still the case that half of individuals diagnosed with cancer will die from their disease. The surface implication of this statistic is that no matter what one does in the face of a life-threatening disease such as cancer, the chances of dying from the disease are significant. Why, then, bother to become involved in treatment decision-making, to lobby for the right to do so, to seek out