Case Study: Withholding and Withdrawing Life-Sustaining Treatment
Josephine is a 74-year-old resident at the Calypso Home. When she was 60, and later at age 71, she had bowel cancer. In both instances the cancer went into remission after 12-18 months of chemotherapy. She has been well since the most recent bout of cancer, but has incontinence and her mobility is more limited than it used to be.
Until a few months ago Josephine’s husband cared for her, but he had a heart attack and died suddenly. Josephine was very dependent on him and has felt lonely and isolated since his death. Josephine and her children decided it would be best for her to move into a nursing home so she can access full-time professional care, and have company.
After six months at the home, Josephine suffers abdominal pain. A visit to Josephine’s oncologist reveals the cancer has returned, but so far it has not metastasised. The oncologist advises Josephine that if chemotherapy is started immediately there is a reasonable chance of prolonging Josephine’s life. An appointment is booked for Josephine to start chemotherapy later that week.
Josephine returns home feeling anxious and upset. This is the third time in her life she will have chemotherapy, and she is unsure if she can cope with it again without her husband. She despises the side effects she experienced previously from chemotherapy which significantly affected her quality of life.
Later that week, at the oncology appointment before the chemotherapy, Josephine advises the oncologist she has given the matter careful thought and does not want the chemotherapy. She explains she has lived a good life, and does not have the energy or desire to undergo chemotherapy again. She would rather enjoy the time she has left with her family, who take her on outings regularly. She does not want to be sick and suffering side-effects. She has discussed her feelings with her children and they support her decision not to have chemotherapy.
After further discussion, the oncologist concludes Josephine understands that by refusing to have chemotherapy she will most likely die, and that she has capacity to refuse that treatment. Josephine later informs the nursing home’s GP and nurses that she will not be having chemotherapy. They are saddened but respect her decision. The law recognises the ability of Josephine to make this decision, and allows (indeed requires) the health professionals to respect it.