Inter-Religious Perspectives on Hope and Limits in Cancer Treatment

Abstract

An 85-year-old woman, a retired nurse’s aide, has advanced metastatic breast cancer to the liver and bone. She recently transferred her care to a new hospital and physician, hoping for better results. Nevertheless, her disease has worsened despite maximal hormonal therapy and several chemotherapy regimens including cyclophosphamide, methotrexate, and fluorouracil, and doxorubicin, paclitaxel, navelbine, gemcitabine, and capecitabine. In addition, she has progressive kidney failure and heart disease. She is weak and nearly bedridden. She also finds it difficult to eat. Her oncologist has advised the patient that additional chemotherapy would not be helpful. He has attempted to shift the goal of treatment from life-prolonging interventions to comfort measures, and has consulted the palliative care team. The palliative care team has suggested referral to a home hospice program. The patient’s two sons, who, with her agreement, are directing her medical care, are unwilling to accept referral to a hospice program. They are upset that the oncologist is ‘‘giving up.’’ At a visit with the oncologist, the patient and her sons bring an Internet printout of the investigational agents angiostatin and endostatin. The oncologist suggests that the patient is too ill to be eligible for an experimental trial and that additional chemotherapy would not help. The patient’s sons express anger. ‘‘I’m very disappointed with oncology,’’ one son says. The patient belongs to a religious faith. She attends religious services, but not regularly. The patient’s sons appear to be very involved with their religion. They have been seen in the treatment area reading their religion’s holy book. Three scholars from the Muslim, Jewish, and Christian traditions were asked to respond to this clinical scenario by briefly introducing their faith’s tradition, and then addressing the case. The question posed to them was whether, and how, a religious perspective on these issues might have helped to illuminate the patient’s and the family members’ understanding of the issues at stake, and potentially have lessened the degree of conflict between family and professional staff.