My mother refused treatment for her breast cancer. Her doctors should have respected her choice – statnews.com

Analysis of Patient-Centered Care in Relation to Sustainable Development Goal 3 (Good Health and Well-being)

Case Study Overview

• A patient diagnosed with breast cancer in 2002 made an autonomous decision to refuse curative treatment.
• This choice was met with systemic resistance, disbelief, and a lack of supportive care from healthcare professionals.
• The patient and her family were deprived of crucial information regarding disease progression, palliative options, and end-of-life planning.
• The case highlights a critical gap in care for patients who do not follow conventional treatment protocols.

Systemic Failures and Alignment with SDG 3

The described experiences demonstrate a significant misalignment with the principles of Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages.

1. Violation of Target 3.4 (Promote Well-being): The healthcare system’s singular focus on curative treatment failed to promote the patient’s mental and physical well-being. By dismissing her choice, providers neglected their duty to manage her symptoms and support her quality of life, which is a core component of managing non-communicable diseases.
2. Gap in Target 3.8 (Universal Health Coverage): The case illustrates a failure in providing access to quality essential healthcare services. The implicit denial of palliative and supportive care to a patient refusing curative treatment reveals a conditional approach to coverage, which undermines the goal of universality. The system created a binary where care was contingent on compliance, not on need.

Implications for Inequality and Institutional Justice (SDGs 10 & 16)

Healthcare Disparities and SDG 10 (Reduced Inequalities)

• The differential treatment based on a patient’s choice creates a distinct form of inequality within the healthcare system.
• Patients who exercise their autonomy to refuse standard medical advice risk becoming a marginalized group, denied equal access to compassionate care, information, and institutional support.
• This bias perpetuates stigma, not only for the patient but also for their family, contributing to emotional distress and unequal health outcomes.

Institutional Failures and SDG 16 (Peace, Justice and Strong Institutions)

• The narrative exposes a failure of healthcare institutions to be responsive, inclusive, and just, as mandated by SDG 16.
• A just institution must uphold the right to bodily autonomy and informed decision-making. The hostility encountered by the patient indicates a systemic weakness in protecting these fundamental rights.
• The lack of a supportive framework for non-conventional patient choices points to the need for stronger, more compassionate, and more accountable healthcare institutions.

Recommendations for a Sustainable and Equitable Healthcare Model

Integrating Patient Autonomy and Palliative Care

To align healthcare practices with the Sustainable Development Goals, the following reforms are necessary:

1. Decouple Supportive Care from Curative Treatment: Establish policies and insurance reimbursement models that ensure patients receive palliative, comfort, and supportive care, irrespective of their decision to pursue or refuse curative treatments.
2. Enhance Professional Training: Implement mandatory training for all healthcare professionals on compassionate communication, patient autonomy, and navigating end-of-life conversations in a non-judgmental manner.
3. Promote Patient-Centered Dialogue: Encourage a shift from a compliance-based model to a collaborative one, where providers work with patients to understand their values and goals, offering a full spectrum of options that includes non-treatment and palliative pathways.

Upholding Dignity in Accordance with SDG Principles

• Meeting patient choices with curiosity and compassion is essential for upholding human dignity, a foundational principle of the SDGs.
• A truly sustainable healthcare system must support individuals throughout their entire life journey, including the process of dying, in a manner that respects their personal values.
• The ultimate objective is to build an inclusive system that provides equitable care for all, ensuring no one is left behind or penalized for their personal health decisions.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article is centered on the experience of a patient with breast cancer, a non-communicable disease. It directly addresses issues of patient care, treatment choices, end-of-life care, and the quality of interaction with healthcare professionals. The narrative explores the need for palliative care and compassionate support for terminally ill patients, which is a core component of ensuring healthy lives and promoting well-being for all at all ages.

SDG 10: Reduced Inequalities

• The article highlights a form of inequality within the healthcare system. The patient was treated with “disbelief and disdain” and effectively denied supportive care because she chose not to pursue curative treatment. This created a discriminatory environment where her choice led to inferior care and stigmatization for both her and her family. This connects to reducing inequalities in outcomes and ensuring equal access to compassionate care, irrespective of a patient’s treatment decisions.

2. What specific targets under those SDGs can be identified based on the article’s content?

Under SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article’s subject is breast cancer, a non-communicable disease. While the patient chose not to receive treatment, the narrative revolves around the management of her illness and the healthcare system’s response to it. The call for better palliative care is directly related to promoting well-being for those living with such diseases.
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The article explicitly questions the lack of a “middle ground” in care, where a patient who forgoes curative treatment loses access to other forms of supportive care. It points to a gap in “quality essential health-care services,” specifically palliative and end-of-life care that is not tied to curative treatment. The author notes, “if a patient chooses hospice care, coverage for curative treatment goes away,” highlighting issues with financial coverage and access.

Under SDG 10: Reduced Inequalities

• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard. The article describes a discriminatory practice within the healthcare system. The author states, “If you choose treatment, you’re a good patient, and you deserve care… If you do not choose treatment, you’re a bad patient, and you deserve no care.” This implicit bias leads to an inequality of outcome, where the patient was met with “hostility, even disgust” and denied compassionate, supportive care due to her personal health choices.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3 Targets

• For Target 3.4: The article directly discusses death from breast cancer. This relates to Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease. The entire narrative is a reflection on the author’s mother’s death from cancer.
• For Target 3.8: The article implies a need to measure the availability and quality of specific health services. The author’s plea for palliative care “even if they’re not being treated” suggests a gap. Progress could be measured by an indicator focused on the availability and integration of palliative care services within the healthcare system, independent of a patient’s choice for curative treatment. This is a specific application of Indicator 3.8.1: Coverage of essential health services. The article suggests that palliative care for patients refusing curative treatment is not currently considered an “essential service” by providers or insurers.

Indicators for SDG 10 Target

• For Target 10.3: The article provides anecdotal evidence of discrimination. An implied indicator would be the proportion of patients reporting discrimination or stigma from healthcare providers based on their treatment choices. The author recounts multiple instances where she and her mother were met with “disbelief and disdain” and judged for their decisions, which is a direct measure of discriminatory practice and unequal treatment.

4. Table of SDGs, Targets, and Indicators

Source: statnews.com