-Disclosure of cancer diagnosis to patients is an ethical, sensitive and controversial issue in health care practice. There have been several studies focusing on merits and shortcomings of informing patients about their diagnosis of cancer. Many studies have been conducted to find out exactly what is the best practice in this regard. However no firm results have been achieved. I find this issue extremely important especially for patients who are at the terminal stage of cancer. It has been observed that prevalent attitude of people in our society forbade disclosing cancer diagnosis to patient, whereas others emphasize practice of honest communication and patient’s right to be informed of their diagnosis. Those people who support disclosure of the diagnosis provide their reasons as it helps a patient to get mentally, physically, emotionally and cognitively prepared about his/her terminal illness. On the other hand, the people who stress no revelation of the diagnosis to patients claim that it will bring a psychological trauma to the patient. Besides, some cultures assume this ailment as a social stigma. Additionally, it is also believed that this disclosure may bring fear of death in the patient or cause impairment of coping for the patient. In my opinion, it is one of the patient’s fundamental rights to be informed about his/her health status and health care personnel should reveal cancer diagnosis to the patient in an appropriate and acceptable manner regardless of varying value belief patterns.
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It is argued that disclosure of cancer diagnosis can worsen patient’s hope and coping. Whenever a person gets a bad news about his/her health, he becomes hopeless and feels the most helpless in the entire world. For instance, according to Kazdaglis et al. (2010), disclosing cancer diagnosis can prove harmful for him/her. Moreover, in view of Angelos (2008), “…in the face of terminal illness, honesty is cruel because it will force patient to lose hope.” (p.73) Furthermore, according to Mukhida and Bernstein (2008), disclosure of the cancer diagnosis may have upsetting effects on the patient and family, along with shock and feelings of fear.
On contrary, I will advocate that early information about the diagnosis helps patient to adopt positively. In general, coping and hope are very much abstract concepts and people perceive these concepts differently but if patient applies his/her coping in adaptive manner, it would become easy for him/her to cope better with the present situation. A research by Yun et al. (2010), exclaimed that most of the patients and family caregivers want the disclosure of terminal cancer. Another article by American Cancer Society (2010) also emphasized that adequate knowledge according to patient’s understanding, if provided, can help patient decrease his/her fear of unknown. Likewise, Nelson (2010) stated that it is better to disclose the diagnosis to patient and that it is unfair and unjustified to keep patient suspicious about his/her health status. According to our Islamic teachings too, it is important to let patient go through his/her grieving process and allow him/her to ventilate the feelings regarding what ever good or bad occurs to him/her. Also by letting know about his terminal disease he/she can make arrangements that would be essential after him/her for example, patient’s will. Furthermore he/she will be able to spend his/her time recalling God asking forgiveness and saying bye to all his/her loved ones properly.
It is claimed that once patient or his/her family members become aware of the illness they may feel socially stigmatized and patient’s self-esteem may deteriorate. According to Vanderbilt-Ingram Cancer Centre (2007), after the disclosure when patients head for treatment, they feel themselves different than others. Similarly according to another article by Breast Cancer Care (2009) if patients lose their visible body parts, it damages their self-esteem too. Equally, Ramsohok (2009) describes that physical and mental changes due to cancer treatment affect patients’ confidence level.
However, I argue that those patients who use positive coping mechanisms can fight from the disease as well as any stigma from the society. Positive thinking can help patient to maintain his self-esteem as earlier. Stephan (2009) affirms that support groups play vital role in coping with disclosure positively. Another article by Oral Cancer Foundation (2010) exclaims that it increases hopefulness in patients. I also firmly agree that coping with the diagnosis disclosure might be very hard but it is not impossible.
It is disputed that diagnosis if disclosed, stressors concerning additional financial burden will be too disturbing for patient. According to Sharp and Timmons (2010) cancer treatment increases financial burdens on the patient and his/her family. In addition, it is very difficult for middle and low income class people to get their complete treatment done. Lowell as cited in Latta (2007) also added that “Discussing the costs of care with patients has become a real issue for doctors” (para. 11).
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I emphasize that financial consideration at a cost of patient’s life is not a wise decision. Instead, we need to assist patient in identifying available and accessible resources (both government and charity) and support from family and community welfare trusts etc., in order to overcome his/her financial burdens. In our country, there are some charitable hospitals who are working for the good of cancer patients including Shaukat Khanum Memorial Cancer Hospital, Bait-ul-Sukoon as hospice for palliative care, Children Cancer Hospital, etc. Those people who are affording and have health insurance policies can take great benefits from it in their time of need.
Thus in view of above arguments, I claim that it is essential for health professionals to inform patients about their diagnosis while providing opportunity for discussions supporting their coping, hope and adaptation or his/her financial stressors. Positive thinking, adaptive coping and hope can make the patient capable of fighting with his/her life’s uncertainties. According to Macklin (2006) “The ethical principle of ‘respect for autonomy’ mandates that doctors treat patients as autonomous individuals and so must inform them about their illness” (p.673). It is very important to have a positive attitude to achieve positive outcome in this controversial run of life. If we won’t disclose cancer diagnosis to the patient, we will be violating patient’s right, which is morally and ethically incorrect and unacceptable and can give harm to the patient’s life.
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