Should the patient and family participate in the decision-making process as to whether or not to pursue an aggressive course of therapy?

Of course, there are those patients who say “Whatever you think would be best doc.”  And there are others who are so mentally incapacitated as to not be able to render an intelligent decision.

But what if a patient wants to help decide on the course of therapy? There are two points of view.  There are physicians who feel that patients and family should not participate in decision-making in aggressive treatments, such as surgery, radiation, and chemotherapy, as they are too emotionally involved and may not think rationally.  I feel otherwise.  Apart from the patient having the right to agree or not agree to a particular treatment, there are situations in which the patient may be in a better position than the physician to decide.  For instance, say a patient has a tumor of the arm and the statistics indicate that there is a 90% chance of survival if the entire limb is removed, but only a 70% chance of survival if the tumor is removed locally, but leaving the function of the arm intact if successful.  What should one do?  Leave the decision up to the physician, or seek the patient’s opinion?  The physician may opt to remove the arm to improve the chances of survival but the patient may want to take the gamble, in order to keep a functioning limb. The patient’s choice may well be the better one; it suits the patient’s individual needs.  The patient and family may be willing to gamble, while the physician may not.

From Med'Toons, by S. Goldberg, MedMaster

If the patient and family are well-informed of the facts, the therapist should encourage their participating in the decision-making. The patient and family not only have the right to do so, but their input may be helpful, even invaluable, in making the right decision.