A recent study conducted by the Rutgers Cancer Institute suggests that terminally ill cancer patients are heavily influenced by moral obligations and guilt when making medical decisions. The researchers found that up to 88% of participants admitted to continuing “minimally beneficial treatments” due to feelings of moral obligation and a desire to support their loved ones. Additionally, a significant number of patients confessed to forcing themselves to appear more optimistic and physically better when surrounded by family and friends, as well as during doctor visits, leading to increased distress.
The study revealed that moral motives were strongly associated with a preference for life-extending care over comfort care, as well as a decreased level of peaceful acceptance of their condition. Lead author, Login S. George, attributed these findings to the societal values surrounding illness care in the United States, where there is a prevailing emphasis on “fighting” and not “giving up” on battling death at any cost. George suggests that patients may feel a sense of failure or disappointment if they consider discontinuing treatments, given these prevailing social attitudes.
The study included 116 participants in the advanced stages of various cancers, such as pancreatic, lung, and breast cancer, with a median life expectancy of under 12 months. When presented with statements like “Stopping anticancer treatments would be a form of giving up on my family,” 45% of participants agreed, with 11.2% expressing that it would greatly impact their family.
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George and his colleagues hope that the study will prompt healthcare professionals to engage in more discussions about the influence of morals, societal values, and external pressures when addressing end-of-life care with patients. By validating patients' feelings and providing them with the permission to discontinue treatment, it is believed that better alignment with their actual wishes can be achieved.
George emphasized, “Helping people articulate their feelings related to needing to continue treatments out of social expectations, or for the sake of others, could produce outcomes that are more in line with a patient’s actual wishes.”