::.. College of Radiology

Palliative Care Symposium: Clinical Decision Making and Ethics in Advanced Cancer – Kuala Lumpur, 18 April 2007

From L to R: Dr Ednin Hamzah, Dr Noreen Chan, Dr Ghauri Aggarwal and Dr Richard Lim who is the Clinical Specialist in Palliative Care Unit of Selayang Hospital

by Dr Evelyn Ho

Hospis Malaysia and University Malaya Medical Centre co-organised a palliative care symposium focussed on clinical decision making and ethics in advanced cancer. This was timely as technological and scientific breakthroughs have enabled rapidly fatal cancers to be controlled and more and more people were living with cancer, including advanced cancers. In other words, technology has prolonged life and postponed death. This translates to greater healthcare costs and an increasing “burden” on already scarce resources.

Ethical principles used in medicine are that of autonomy (freedom of self determination), beneficence (doing good), non-malfeasance (doing no harm) and justice (fairness). Issues of informed consent/consent to treatment options, duty of care of doctors, justifying clinical investigations in advanced cancer, oncology endpoints, ethical issues in truth telling, compassionate care, therapeutic options in the dying, ethical considerations in children with advanced illness and euthanasia – “dignified death or simplified killing?” were covered in this one day symposium.

Consultant Physician in Palliative Medicine and Head of Department of the Palliative Care Unit, Concord Hospital, Sydney, Australia - Dr Ghauri Aggarwal emphasised the following point to the audience, which was made up of paramedical staff, doctors interested and those practicing palliative care medicine primarily: Doctors should not say “we can’t do anything more for you” as there was still a lot more to do for support and care! Yet the issue of medical futility had to be recognised – that is, when a doctor should not provide futile medical treatment. Futile medical treatment would include treatment that would not produce the benefits sought by the patient; that results in temporary and fleeting benefits that do not improve conditions and that which prolongs the dying process and offers no realistic change of improvement. Futile medical treatment could be distinguished as quantitative or qualitative.

“End of Life” discussion and what may happen must be discussed as soon as possible. Realistic discussion of cardiopulmonary resuscitation and the outcome was important so that caregivers and relatives would not feel guilty. A documentation of “no active resuscitation” does not mean “no more care” either. It was important for the doctor primarily in charge of a patient to communicate the end of life care plans to his/her colleagues, especially during off duty hours or in an emergency situation.

In addition to Dr Ghauri Aggarwal, the faculty included:
Dr Rosalie Shaw, Executive Director of Asia Pacific Hospice Palliative Care Network, Singapore; Professor Norchaya Talib, PhD, Faculty of Law, University Malaya; Dr Noreen Chan, Medical Director, Dover Park Hospice, Singapore; Dr Anita Bustam, Head of Department of Radiotherapy & Oncology, University Malaya Medical Centre and Dr Ednin Hamzah, CEO/Medical Director of Hospis Malaysia

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Last Updated:
Monday, 21 January 2008