Problèmes éthiques soulevés par la prise en charge thérapeutique des patients âgés déments atteints de cancer

Abstract

Medical progress and the prolongation of life expectancy give rise to new situations. Should we treat an elderly dementia patient who has been diagnosed with cancer ? Simply asking this question disturbs conventions, and the widespread social and medical attitude of agism. Multiple mechanisms concur to agism : negative views on old age, fear of death⋯ In terms of values, the priority our society gives to freedom, autonomy, and efficacy represents a particular risk of stigmatisation for elderly dementia patients with cancer. Questions of justice arise in resource allocation and distribution criteria. In practice, clinical management of such patients with cognitive deficits forces reflection on notions such as information, quality of life, and consent, which can be assisted by a designated third party or advance directives. Between therapeutic obstination and negligence, the search for a middle ground is necessary. The importance of intention, the influence of context, the requirement to make a justifiable choice and to maintain it, the use of a methodology which recognises that deliberation has ethical value, the need to continuously readjust, and the focus on individual responsibility, are helpful elements. Offering a dementia patient a chance for treatment, be it only to consider and then recognise reasons to withhold it, is to honour this patient's dignity, and to reconstitute his human dimension when it is questioned by dominant values such as freedom, efficacy, and happiness. © Médecine & Hygiéne.