Oral Presentation Australasian Association of Bioethics & Health Law and New Zealand Bioethics Conference

The limits of autonomy in advanced cancer and palliative care. (938)

Russell J Shute 1
  1. Calvary North Adelaide Hospital, North Adelaide, SA, Australia

An increased focus on autonomy in the last half a century has resulted in necessary changes in the therapeutic relationship between patients and physicians but in an environment of rapid development and availability of cancer therapies in which patients expectations have changed partly due to increasing access to online information (including social media) and arguably an increased sense of entitlement for treatment the management of advanced cancer (including palliative care) can be compromised.

The author contends that cancer patients are often acting as 'consumers', that is there is a belief that there is a commodity or 'good' to be obtained within a market and a desire to access such a  'good' despite not necessarily understanding the complexity of action, side effects, costs or  benefits.The ultimate motivation for such action would appear to be life extension at all costs , especially in younger and wealthier patients, but there is evidence that this can undermine the provision of realistic and ‘good’ medical, especially palliative, care.

The proposal is that there are justifiable grounds to limit autonomy when patients or their families request the provision of futile and often expensive treatment that arguably complicates and worsens outcomes in advanced cancer.   The talk is given by a Palliative Care clinician with a postgraduate qualification in bioethics and will include clinical vignettes demonstrating how care has been compromised by oncologists acquiescing to patients requests or demands for often expensive, and arguably futile, therapies.