When there’s no cure, what’s the best treatment?

by Madeleine Kolb

Is there any question more anxiety-provoking, more terrifying, more contentious than what kind of medical care a sick person should have when the possibility of a cure is zero?

Two options

At one extreme is the full-throttle option–hit her with the complete arsenal of medical weapons available even though none will cure her. At the other extreme, provide palliative care, including pain medication, to keep her as comfortable as possible and relieve her pain.

These days, the full-throttle option is far more common, more conventional. Not because it cures people, but because many doctors see it as their mission or duty to keep even terminally-ill patients alive as long as possible, many family members demand it, and many patients don’t know that they have options.

Are we talking about rationing health care here?

 So in this atmosphere, it’s been most illuminating and inspirational to see a post on the subject by health care professional Amy Berman, recently diagnosed with Stage IV inflammatory breast cancer.  Amy writes personally and so powerfully about her recent eye-opening journey through the U.S. health care system.

Jill’s story

Amy Berman’s words made me think of Jill Byington, a wonderful woman I worked with in Seattle. In June or July, 2009, Jill was diagnosed with metastatic Stage IV triple negative breast cancer. She was a terrific writer and during her treatment, she blogged about her illness and other matters.

Jill died on December 8, 2010. Several months before that, she wrote:

You know, cancer has never really made me feel sick. Chemotherapy has, but I’ve never had symptoms from the cancer. Maybe if I let it grow without removing it through surgery or radiation I’d have symptoms, and maybe if it were more advanced…. but then, how more advanced does cancer get than “terminal”? Chemotherapy has, in fact, made me want to give up and die many times. Cancer hasn’t.

I’ve mentioned to my doctor and a few of you more than once that I really don’t see the point in going through 24 months of torturous treatment to buy a statistical five more months of life. What is the point of being completely miserable for 29 months total? Why not have 24 months of relative peace and comfort and go to heaven 5 months sooner?

Patient-centered treatment

Both these woman are part of a powerful and growing movement toward patient-centered treatment, meaning treatment that’s chosen by an individual patient as right for him or her. Treatment that may allow her to live out the time remaining in relative peace and comfort. Perhaps that’s the best treatment of all when there’s no possibility of a cure.

What kind of care would you want for yourself or a loved one, if there were no cure?

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