It's ok to say no! A discussion of ethical issues arising from informed consent to chemotherapy

This article is written in response to anecdotal evidence from patients, reports from nurses, sociological studies, and documentation from oncologists, which all suggest that the process of refusing treatment for chemotherapy is not an easy one. There is substantial evidence to suggest that pressures that are counterproductive to informed consent are having an impact on the decision making of vulnerable individuals coping with the stress of terminal illness through cancer. Informed consent is a basic ethical principle underpinning any medical or nursing intervention (Johnstone M. Bioethics: a nursing perspective. Sydney: Harcourt Brace Jovanovich, 1989). The following focus on informed consent is an attempt to begin to address the present hiatus which exists in the health literature on ethical issues surrounding the modality, chemotherapy (Young D. An ethical approach to chemotherapy in private practice. J Natl Cancer Inst 1992;84:810). Recent research suggests that the holistic orientation of nurses, in comparison to the reductionist stance of physicians, allows them to be emotionally close to their patients and hence, more aware of the difficulties individuals experience in coping with stressful regimens (Uden G, Norberg A, Lindseth A, Marhaug V. Ethical reasoning in nurses' and physicians' stories about care episodes. J Adv Nurs 1992;17:1028-34). Consequently, it is anticipated that ethical issues in relation to chemotherapy, a modality that has been described as distressing and capable of seriously compromising quality of life (Burish T, Tope D. Psychological techniques for controlling the adverse side effects of cancer chemotherapy: findings from a decade of research. J Pain Sympt Man 1992;7:287-301), will have an impact on the working life of many oncology nurses.