This paper examines the ethical and clinical challenges that arise when a terminally ill patient refuses further treatment. Using a case study of a 57-year-old woman with stage 4 cervical cancer, the paper explores the principle of patient autonomy, the irrationality of guilt-driven treatment refusal, and the therapeutic value of Rational Emotive Behavior Therapy (REBT). It also addresses the role of palliative care in improving quality of life when curative treatment is no longer viable. The paper integrates ethical principles with practical counseling approaches to propose a compassionate, patient-centered plan of care.
The paper demonstrates applied case analysis: it uses a specific clinical scenario to illustrate broader theoretical and ethical concepts. Rather than discussing REBT or palliative care in the abstract, the author consistently ties each concept back to the patient's circumstances, showing how academic frameworks guide real-world clinical decisions.
The paper opens with a detailed case presentation, then frames the ethical dilemma through the lens of patient autonomy. It proposes REBT — and specifically the ABC model — as the counseling intervention, justifying the choice by linking the patient's guilt-driven beliefs to the model's core focus on irrational cognitions. The paper closes by recommending palliative care as the appropriate treatment pathway, emphasizing sensitivity and honest communication with the patient and family.
Jane is a 57-year-old African-American woman who was diagnosed with stage 4 cervical cancer two months ago. At this advanced stage, the disease is largely considered terminal. Following clinical review, doctors indicated that the disease could not be cured and, therefore, there was no need to pursue aggressive or advanced treatment aimed at curing it. A decision was made instead to place Jane on treatment focused on controlling her symptoms. Specifically, it was recommended that she undergo radiation therapy with the aim of controlling her symptoms, stopping bleeding, and easing pain.
Jane's family has been very supportive. She is married to Jordan, a 64-year-old veteran. Together, they have three adult children, all of whom are married.
Over the last two weeks, Jane has been showing signs of distress and anxiety. She has expressed a desire to "leave this planet" as soon as possible in order to ease her family's suffering and "release them to pursue other more meaningful engagements in life." She is concerned that they are "unnecessarily spending resources" on her and is convinced that she is "wasting their time" through constant visitations and the various demands of care. She sees the stoppage of treatment as the only way to hasten her exit, and as a result, she has refused further treatment.
It is important to note that, in line with the principle of autonomy, patients generally have the right to refuse care and treatment. As Davey, Rathmell, and Dunn (2016) explain, this principle holds that "every person has the right to make informed decisions about their healthcare and that healthcare professionals should not impose their own beliefs or decisions upon their patients" (p. 107). Given this ethical foundation, the appropriate response is not to override Jane's stated wishes, but to deploy relevant counseling approaches in an effort to help her make a more fully informed and emotionally grounded decision.
In this case, Rational Emotive Behavior Therapy (REBT) is a well-suited counseling approach. REBT has been described by Conte (2009) as a form of cognitive-behavioral therapy (CBT) that focuses on enabling individuals to identify and rein in their irrational beliefs, and to develop the skills needed to gain better control of their thoughts. As Conte further notes, this makes it an ideal approach for working with individuals whose distress stems from irrational thinking patterns.
In Jane's situation, her belief that she is overburdening her family with her healthcare needs is largely irrational and not grounded in fact. Her family is financially stable, and her husband and children have demonstrated a clear and sustained commitment to supporting her wellbeing. The specific tool to be used within REBT is the ABC model. In Conte's (2009) words, this model "explains how, while we may blame external events for our unhappiness, it is our interpretation of these events that truly lies at the heart of our psychological distress" (p. 179). By working through the ABC model with Jane, a counselor can help her recognize that her distress is driven not by the objective reality of her situation, but by her own interpretations and beliefs about that reality — interpretations that can be examined, challenged, and reframed.
As noted above, doctors have ruled out the need for curative intervention. In this context, the relevance of palliative care cannot be overstated. Jane should be placed on a palliative treatment plan for cancer, wherein the primary goal is improving her overall quality of life and deploying various strategies to minimize suffering (Saracino, Rosenfeld, Breitbart, & Chochinov, 2019). It is essential that both Jane and her family members are made aware of the purpose and benefits of palliative care. In doing so, sensitivity is paramount — specifically, respecting the family's viewpoints and perspectives. At the same time, a straightforward and honest tone must be maintained. The pros and cons of the various available palliative care options should also be thoroughly explored with the patient and her family.
Conte, C. (2009). Advanced Techniques for Counseling and Psychotherapy. Springer Publishing Company.
Davey, P., Rathmell, A., & Dunn, M. (2016). Medical Ethics, Law and Communication at a Glance. John Wiley & Sons.
Saracino, R. M., Rosenfeld, B., Breitbart, W., & Chochinov, H. M. (2019). Psychotherapy at the end of life. American Journal of Bioethics, 19(12), 19–28.
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