Curing the Incurable
Andrew Rynne
I am a retired medical practitioner and the Author of two published books, with a third on its way.. - The Reverend Psychopath, The Foxhunter. -- a tragedy of medical negligence and an autobiography.
Curing the Incurable
Asked recently on Quora why John McCain declined treatment of his brain tumour an oncologist had this to say:
Of course I don’t know the details of John McCain’s glioblastoma multiforme but I’ve treated my fair share of patients. Typically there is a brief remission after debulking surgery where some but not all of the cancer is removed, followed by brain radiation therapy and the oral chemotherapy pill Temodar. Probably a course of Avastin, an IV angiogenesis inhibitor is added at sometime.
Invariably the cancer returns and causes major neurological dysfunction. That could include inability to walk, inability to think clearly and difficulties with speaking.
At some point in time, the treatments become futile and/or a patient’s quality of life decline to a point not worth continuing.
For everyone, that point is different so I’ll advocate that all of us complete an Advanced Directive, a legal document setting out what each of us wants done for us if we become unable to make the hard decisions about continuing or discontinuing therapy.
The large majority of us don’t want our life prolonged if it’s just a matter of lengthening our time of suffering.
John McCain, as a very thoughtful and intelligent individual, would have completed an Advanced Directive and also verbally instructed his wife and children regarding his end of life wishes. He doesn’t strike me as the kind of person to leave things to chance or to put the painful responsibility of making tough decisions at the end of his life in the hands of suffering family members.
I made the following observation however:
If at some point in time the treatment inevitably becomes futile then, logically, it was futile from the very beginning. Futile medical treatment is not only unnecessary, it may also be bad medicine and malpractice.. Oncologists in particular seem to have difficulty grasping this simple concept. There is a distinction between prolonging life and prolonging death and we all need to think about this.
95% of brain tumours are incurable. That being so put your affairs in order, embrace death and call for the morphine. Above all, keep oncologists at bay.