Medicine: Cancer & Conscience

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Cancer, a deadly disease that the doctor has to attack with inadequate tools and insufficient understanding of the cause, gives the medical profession its two most painful problems of conscience: Should life be prolonged, even at the cost of pain to the patient, if the doctor is convinced that the patient is dying? And should the doctor tell the patient that the disease is cancer as soon as the diagnosis is certain? Last week 1,000 medical scientists and 450 laymen at the annual meeting of the American Cancer Society in Manhattan heard an eloquent answer to the first question, and a helpful statistical answer to the second.

How Long to Prolong? A vigorous defense of what he called "aggressive or extraordinary means of treatment" to prolong life came from Dr. David A. Karnofsky, of Sloan-Kettering Institute for Cancer Research, who was recently called in as a consultant on the treatment of House Speaker Sam Rayburn.

As the patient continues in a seemingly inexorable decline, said Dr. Karnofsky, "the state of dying may be protracted by expensive and desperate supportive measures, and the patient is rescued from one life-threatening situation only to face another. Many objective observers, in contemplating this dismal scene, plead with the doctor to let the patient go quickly, with dignity and without pain."

With rising indignation he continued:

"Withholding of aggressive or extraordinary treatment can be urged and supported by state planners, efficiency experts, social workers, philosophers, theologians, economists and humanitarians. For here is one means of ensuring an efficient, productive, orderly and pain-free society, by sweeping out each day the inevitable debris of life." Roundly rejecting any such advice, Dr. Karnofsky said that life must be prolonged on the ground, among others, that there is always the hope during a temporary reprieve that science will find a more effective and longer-lasting treatment.

Temporary relief can be stretched a long way. Dr. Karnofsky cited the case of a patient with cancer of the large bowel. A colostomy relieved an intestinal obstruction. A recurrence of cancer nearby was relieved by X-ray treatment. When the abdominal cavity began to fill with fluid, radioactive phosphorus checked the process. Bronchopneumonia was cured by an antibiotic. Cancer spread to the liver, and again X-rays were used. As liver function progressively declined, many medical measures supported the patient. If some of these treatments had been withheld, said Dr. Karnofsky, the patient would have died within weeks or days. Successively, they kept him alive for ten months. Dr. Karnofsky asked, "When should the physician stop treating this patient?" and answered: "I believe he must carry on until the issue is taken out of his hands."