Guilt and shame often drive terminally ill cancer patients to undergo minimally beneficial treatments, according to new research from Rutgers. This study has revealed that patients may feel a moral obligation to continue treatment despite poor prospects for recovery.
Login S. George, a health services researcher at Rutgers Institute for Health, Health Care Policy and Aging Research, stated, “In the United States, advanced illness care is enveloped in a set of moralized social attitudes around ‘fighting’ and ‘not giving up,’ where death is seen as the enemy, to be fought off at all costs.” George is also a research member of the Cancer Prevention and Control Program at Rutgers Cancer Institute and the lead author of the study published in Health Psychology.
According to George, patients often experience a moral dilemma when considering the discontinuation of treatments, feeling like they are failing a moral code or disappointing others. The study, which is among the first to quantify these sentiments, included 116 terminally ill cancer patients recruited from the Rutgers Cancer Institute and other clinical sites between April 2022 and March 2024. These patients, who had a median life expectancy of less than 12 months, were in the advanced stages of cancers including pancreatic, lung, colorectal, or breast cancer.
Structured interviews revealed that guilt and a sense of duty often pushed patients to continue nonbeneficial treatments. In a noteworthy finding, up to 88% of participants said their decision to continue treatments was influenced by moral obligations or for their loved ones' benefit. Some patients expressed stopping treatment felt like "giving up on my family."
Additionally, up to 86% of patients reported that they tried to appear more optimistic and healthier in front of loved ones and oncologists, even when feeling distressed. This behavior was linked to increased patient distress.
George highlighted that previous research focused on guilt from burdening others with care, whereas this study addresses guilt from not "battling cancer optimistically." He emphasized the importance of open dialogue for ideal decision-making regarding treatment continuation.
The study suggests significant implications for end-of-life planning in advanced illnesses. Families, medical professionals, and loved ones are encouraged to consider patient motivations more thoroughly and support their choices, allowing them to discontinue treatments not deemed worthwhile.
George commented, “Typically, doctors present people with information about treatment options and ask them what they want to do. These results suggest we need to go a step further and discuss moral sentiments. Helping people articulate their feelings related to continuing treatments out of social expectations, or for the sake of others, could produce outcomes that are more in line with a patient’s actual wishes.”
