Treatment choice is ultimately the patient's

Ethics Forum. Oct. 4, 2004.

When patients tell of alternative therapies, what do you say?

A patient who has cancer and a poor prognosis informs you he wishes to try alternative treatments including a macrobiotic diet, colonics, and positive imaging to purify his body of toxins and focus the healing powers of his mind. How do you respond?

Reply:

Each individual has the right to determine what medical treatment he or she will receive, including what life-sustaining treatment will be provided for a terminal condition. It is the physician's responsibility to advocate for the patient's right to choose any therapy, including alternative or nontraditional treatments, that reasonably may be expected to improve the patient's quality of life.

In the case of this hypothetical patient with cancer and a poor prognosis, I would respond affirmatively to his expressed wish to use alternative treatments, including macrobiotic diet, colonics and positive imaging, as long as it will not further harm him. Even if there is no scientific evidence to support his choice, as long as the measures won't harm him or his family or worsen his quality of life, it is important for him to use therapies he believes will make him feel better. My purpose is to support my patient and to provide advice and information.

I won't be silent, however, if I believe that a therapy could cause harm to him or his family. If I believe it will worsen the quality of his remaining life, I will speak up. I will also tell him if there is no proven benefit, or if the treatment has been shown to have both beneficial and harmful effects.