Module 1 – Promoting Patient Well-being
Ethics Case 1.2
Miss Dior’s Conflicted Choice
Miss Dior, a 38-year-old woman, recently received a stage I breast cancer diagnosis and was referred to Dr. Bergkamp, a well-regarded surgeon, to explore surgical options for tumor removal. During the appointment, Dr. Bergkamp strongly recommends a mastectomy which involves the removal of all the tissue in one or both breasts. A mastectomy removes not only the cancerous tissue, but also all of the surrounding healthy breast tissue, in order to ensure that the cancer has nowhere left to spread. Dr. Bergkamp explains that he prefers to perform mastectomies due to his extensive experience and proven track record with the procedure, including minimal complications and relatively few cancer recurrences among his patients. While Miss Dior feels reassured by Dr. Bergkamp’s expertise and successful outcomes, she also leaves the consultation with significant anxiety about undergoing such major surgery.
Following her appointment, to ease her concerns, Miss Dior conducts some online research into breast cancer treatments. To her surprise, she discovers that for women in her age group with early-stage breast cancer, a lumpectomy represents an equally viable alternative to mastectomy for tumor removal. A Lumpectomy (sometimes referred to as a “partial mastectomy”) involves the removal of only a small portion of the breast tissue, enough to remove the cancerous tissue and some of the surrounding healthy tissue, while trying to preserve as much of the healthy breast tissue as possible. Her research indicates that while a mastectomy might offer greater psychological reassurance through complete breast removal, it is also a much more invasive operation typically requiring subsequent reconstructive surgery and an extended healing period. In contrast, a lumpectomy would maintain most of her breast’s natural appearance and feeling, would also risk fewer surgical complications, and would have a significantly shorter recovery time.
The advantages of a lumpectomy greatly appeal to Miss Dior, especially since she has recently started preparing for an upcoming dance recital. While she knows her practice will need to be put on hold, she hopes that a lumpectomy will allow her to get back on her feet more quickly and ideally in time for the performance. Given Miss Dior’s dedication to dance and her generally active lifestyle, she considers the reduced recovery time and elimination of reconstructive surgery as significant advantages. So although her primary focus is on her health and eliminating the cancer, after thorough deliberation and extensive discussions with her family members, Miss Dior decides that she would like to speak with Dr. Bergkamp again about the possible advantages of choosing lumpectomy over mastectomy.
However, at their next appointment, Dr. Bergkamp’s response catches Miss Dior off guard. Despite acknowledging that there is no statistically meaningful difference in survival outcomes between stage I breast cancer patients who received lumpectomies compared to those who had mastectomies, Dr. Bergkamp maintains that his professional training and clinical experience indicate that a mastectomy is superior for preventing cancer recurrence. He expresses his desire to spare Miss Dior from emotional trauma and potentially additional surgeries to remove more tissue if her post-surgical pathology results reveal positive lymph nodes or indeterminate margins. Once again, Dr. Bergkamp focuses on emphasizing the substantial advantages of mastectomy for Miss Dior’s consideration, continuing on to say that “when dealing with breast cancer in a woman of your age, there is no such thing as too much caution.”
Miss Dior again leaves his office feeling a bit bewildered and emotionally overwhelmed. Although her own research and conversations with her family had convinced her that a lumpectomy represented the optimal choice for her lifestyle and situation, she also holds deep respect for Dr. Bergkamp’s seasoned clinical expertise and his genuine concern for his patients’ welfare. Given that both treatment approaches yielded similar results, Miss Dior questions whether she should set aside her personal preferences and follow Dr. Bergkamp’s professional recommendation, or whether he might be basing his judgement more on his own treatment preferences rather than taking her concerns into account..
