FIAMC Bio-Medical Ethics Centre Mumbai INDIA

(FIAMC: Federation Internationale des Associations Medical Catholique)
The FIAMC Bio-Medical Ethics Centre [FBMEC] was established in Bombay in September 1981 to study and debate the ethical status of various actions - experimental, diagnostic or therapeutic - in the bio-medical field within the ethic of culture, religion and the modern secular state. MORE

Glimpse Into The Proceedings of The Forum on Ethical & Legal Dilemmas In Orthopaedic Practice

Presented by

in association with
Sunday, 21 September 2008

Convenor: Dr. N.A. Antao Co-Convenor: Dr. Manhar Shah
Proceedings prepared by: Dr. Stephen Fernandes

We Treat, God Cures!

Dr. L. J. de Souza

After almost 40 years of treating thousands of cancer patients, I have now removed the word “cure” from my vocabulary when talking to my patients. And believe me, I have good reasons for doing so!

Firstly, we must go down to the grass root levels and understand what the world “cure” means. Amongst the many meanings listed for “cure” in the Oxford Dictionary are “restore to health” and “eliminate disease”. My own understanding is that, to restore to health means healing has occurred, but it does not mean the disease or malady cannot recur at a subsequent date. However, if the healing is permanent, and the disease “totally eliminated”, never to come back again, we can perhaps use the word “cure”. Which man can honestly say that, especially in the treatment of cancer? I believe that only God in his Infinite Wisdom can!

The reasons that I, as only an instrument of the Master Healer, cannot use the word “cure” are as follows:

1. As per my understanding, every last cancer cell from the body must be removed before we can pronounce somebody totally “cured”. Even the wisest physician and the most sophisticated test available to us today cannot truthfully allow us to say this.

2. All our treatments, whether it is surgery, radiotherapy, chemotherapy, or any other modality, singly or in combination, treat only the effects of the cause. This is because till today we do not know the cause of a particular cancer. There are of course many theories but certainly nothing conclusive. Hence, if we do not know the cause how can we remove it totally, and if the cause persists, what guarantee is there that the cancer will not recur again? Therefore, how can we say “cured”?

3. The yardstick used to define a so called “cure” was the period the patient survived disease-free after the treatment of the cancer. Initially it was a 5 year period. Then as patients survived longer with better treatments, the period of survival went up to 10, 15 and even 20 years. But even that was not adequate, as in some cases, the cancer recurred after 25 or 30 years or even more. So again, when can we truly say a person is cured? I remember an incident in my out-patient department, when a patient came for follow-up 20 years after her treatment for breast cancer. I was elated and jubilantly invited all my students to see the case as it indicated that cancer could be cured. However, when I examined her, I had to hang my head in silence – she had developed another cancer on the other side! Oncology is therefore, the best school for humility and for down staging the ego, because you never know the end result. We are humbled every day!

4. After completion of treatment, we ask our patients to come for periodic follow-up examinations. Initially, they are at shorter intervals and after the period of survival increases, they are at longer intervals. However, they must be ongoing for the rest of the patient’s life. If we were so confident of a cure, why should we ask the patients to come for indefinite follow-ups? The reason is, we cannot because we just do not know all the answers.

And yet, you will find doctors, healers, religious and others, freely using the terms “I can cure you” or pronounce that “You are cured”. Is it ethically and morally right to say that? In fact, it is a blatant untruth, only fooling the patient into a false sense of security. I would go a step further. By using the word “cure”, you are taking the place of the Divine, because only God can know everything and thereby we are going against the first commandment which clearly states “I am the Lord, your God. You shall not have other Gods than me.”

Further, by using the word “cure” we are doing even greater harm. If a patient is pronounced “cured” by a reputed doctor or even a religious faith healer, why should he go for any further treatment or even further follow-up examinations? This false assurance of being cured has led patients to let tumors grow before their eyes because of blind faith in the falsely pronounced “cure” which brings them to us in a very late stage of the disease when we can do little or nothing for them. Such “cures” have doomed many an early case to become advanced and beyond useful treatment. Are we ethically justified in doing this? And if we do this great injustice, what will we answer the Master Healer?

However, we can never remove Hope from the patient, because man lives on Hope. Where there is Hope, there is Life, and where there Life, there is Hope. Therefore, we can never say to the patient that, “You will not be cured”. What we can truly say instead is that, with our modern treatment facilities we are able to “control” the cancer for long periods of time during which the patient leads a normal life. And, if the control is good for many years, the patient can equate it to a cure, although we can never say it. So instead of saying ”we can cure you” or “you are cured”, we can truthfully say, “we can control the disease effectively” or “you are well controlled”.

I am asked ever so often the question: “Doc, how long have I to live?” A terminally ill patient at the Shanti Avedna Sadan was given a specified period to live after his treatment for cancer by his doctor. So he carefully calculated his “due date” to meet the Master and sent cards to all his friends and relatives informing them of the same. The “due date” came and went and here he was very much alive. He had to send cards all over again to say that he was still alive and kicking! Another lady with advanced ovarian cancer was told by her doctor that she had only 6 months to live. When she came to me we treated her as best as we could and by God’s grace she responded very well and remained controlled for well over 8 years or more till I lost contact with her. And I know of many a case where the doctor has given the patient a specified time to live and the patient has well outlived that, only to bury the doctor! I have chosen not to come into this category. So when my patients ask me: “Doc, how long have I got?” I tell them, “Live fully one day at a time and the days will grow into weeks, the weeks into months and the months into years.” How many? God only knows, but who cares, because if you have lived fully one day at a time, you have fully and happily utilized whatever time has been given to you. Does anything else matter?

I am also very often asked, “Will the disease come back after completing treatment?” Again, I cannot give an answer, so I tell them my theory of “Possibility and Probability”. Technically, anything is possible and of course there is always a “Possibility” that the disease will come back. The “Probability”, or the chances that the disease will come back, depends on the various prognostic factors of a particular case. Depending on these we can tell the patient whether the prognosis is good, fair or poor. Of course we always try and give the good news to the patient, but it is a must that the bad news is always told to at least one responsible member of the family so that it does not come as a nasty surprise. However, a definite answer to the question is never possible.

And so, when you next visit your doctor, please don’t ask him: “Am I cured?”, “How long have I to live?”, “Will my cancer come back?” Ethically and morally he cannot answer the questions, simply because he honestly does not know. Always remember:

To treat is human … you and I
To cure is Divine . . . and Divine alone!