Are we at medical limits and not admitting it?
Stem cell transplants still a questionable therapy
By Donna R. Taylor, JD, MA
Bioethicist
Medical Ethics Consultant
Milwaukee
"Hope is the thing with feathers that perches in the soul and sings the tune without the words and never stops at all." — Emily Dickinson
Reporting facts acknowledged by an enlightened medical community for quite some time, the New York Times recently published an inevitable and troubling series. Those stories empirically confirmed that stem cell and/or bone marrow transplants (SCT) are wholly ineffective as a treatment for women with metastatic breast cancer.
Originally, third-party payers refused to include autologous SCT for breast cancer as a covered service, contending that the treatment was experimental. However, after hostile multimillion-dollar judgments, insurers throughout the nation, as a defensive measure, capitulated and paid for the "therapy."
Despite costs ranging between $80,000 and $200,000 per treatment, thousands of women have undergone the grueling course of SCT. Desperate women — already weakened by advancing cancer — arduously "won" the right to devastate their already compromised immune system to prepare for the transplanted cells.
However, such a compelling quest should not be denigrated. This hideous and loathsome disease assaults women, often in their prime. Even well-meaning oncologists may have lacked necessary expertise, mettle, or compassion to admit that — at least for today — medicine may be at the limits of appropriate breast cancer treatment. Similarly, courts cravenly refused to interpret unambiguous contractual language excluding unproven treatments from health plan responsibility.
Who could blame them? Despite the fact that chemotherapy alone had identical survival rates to chemotherapy plus SCT, the addition of SCT to treatment plans gave women something more. It gave them hope. Neither the august profession of medicine nor law could bear to take that away.
Hope, like faith, has very real benefits to the spirit as well as to the immune system. Hope is therapeutic. Because it is wholly subjective — if defined conceptually without precision — hope can never be "false." For instance, to hope for a fulfilling career is one thing. It is quite another if that hope specifies that career be as starting pitcher for the New York Yankees.
It would be a disservice to deny survivors hope for a cure. However, if that hope is grounded on capricious and unproven therapies, the predicate is cruel and deprives patients of realistic hope. Hopes are as many and varied as the women who cherish them. Even allowing for the pervasive longing for imminent cure, many of the other hopes of breast cancer survivors may be universal, and include that:
• she will establish or continue mutually fulfilling relationships;
• her physicians are knowledgeable, erudite, and expert in caring for her;
• she will be told the truth;
• her physicians, respecting her right to know the details of her illness and prognosis, will inform her of those details in a compassionate way, appropriate to her sensibilities;
• she will be allowed to make her own informed treatment decisions;
• she will not be defined by her illness;
• she will not suffer overwhelming pain;
• she will be informed of all medically appropriate interventions without regard to her ability to pay for them;
• she will be treated with dignity;
• she and her loved ones will be supported in coping with an erratic disease process.
Inflicting traumatic, unproven interventions upon seriously ill women, who are deceived about the likelihood of success of those interventions, may provide some short-term therapeutic benefits, secondary to hope. But, that benefit abruptly pounds against a brutal wall when the intervention fails. When plucked clean, hope — with its healing benefits — vanishes. However, should hope be hitched instead to a patient’s absolutely achievable goals? Its value endures as will the quality of her life.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content