Personal Values, Cures and Healing

BY ARLENE HARDER, MA, MFT

Learn how to discover what you, personally, want from your medical treatment and how to reinforce your choices.

What Do You Want Your Treatment to Accomplish?

The often impersonal climate in today's health care system is seldom geared to helping you discover what you, personally, want. Especially when busy doctors are almost forced by the system to see you as a disease rather than as a whole person, it is easy for you to be given treatment that may not meet your needs or reflect your values, personality and coping style. This is compounded by the fact that, at least in the United States, there is an assumption that patients want to be cured (or live as long as possible) and that serious illness must therefore be treated aggressively.

Many patients agree with this perspective. They cling to the hope they will be cured — ;and have every right to feel that way. Even if you are over eighty years of age and your doctor is discouraging you from trying a more arduous treatment because he or she feels it "would not be worth the effort" because of your age, you have the right to have that treatment if you wish and if it wouldn't actually harm you..

But what if trying to live as long as possible — despite low odds — ;is not your goal? What if, for you, the potential "long shot" of an experimental procedure does not seem worth the potential pain and discomfort of side effects? Then you have the right to have your treatment plan match (as closely as possible) your needs and desires. You have the right to use a milder conventional treatment, perhaps in combination with adjunctive techniques, that offers an even lower chance of success — ;or even to not have treatment at all.

Naturally, since not all treatments produce the same side effects in all patients, decisions would be easier if you could know how much discomfort and pain you will need to endure with a given treatment. Also, these decisions would be much easier if there was a crystal ball that could tell you what your life will be like in one, five, ten or twenty years if you followed plan B rather than plan F. (In case you're interested, I'm currently working on a Premature Hindsight Machine which will make me billions, but there are a few kinks I haven't yet been able to work out.)

Consequently, one of the most important factors in exploring treatment decisions is knowing clearly what your goal is for treatment. Are you willing to go for broke no matter what you have to endure? Or are you comfortable accepting a limited lifespan and limited mobility?

In any case, it is important to remember that no matter whatever treatment you choose, even if you decide to have the most conservative approach, you can be healed even though you may not be able to be cured. It's a distinction that is often overlooked.

Confusion Between Curing and Healing

A cure is the result of a procedure that allows you to recover fully from an illness, much as an operation to repair an injured disk can cure backaches or a cast can return full mobility to a broken bone. Healing, on the other hand, is an inner process that allows you to become more whole and to experience peace of mind and a greater sense of well-being — ;no matter what the physical consequence may be.

There is nothing wrong with wanting to be cured! However, when you search for your own pathway to healing (rather than concentrating only on being cured or on blindly following what others would have you decide), you can often optimize your chance for physical recovery. Further, if you can realize that healing comes in large part from surrendering to life just as it is, then you may discover your life takes on new meaning. You may come to appreciate even your "bad" days and feel more alive and live more fully than you had before your diagnosis. (See the sidebar "Every Day Counts, Even Bad Ones" for the article on Supporting Hope.)

A willingness to seek healing encourages us to move toward higher levels of awareness, toward expression of such qualities of the human spirit as courage, patience, love, creativity and beauty. We can move toward expanding, if not necessarily extending, life and toward becoming more fully the person we want to be.

Finding the Right Conditions for Healing Requires Answering Some Questions

Fortunately, in striving for healing you need not rely only on the help that modern medicine can offer. You, yourself, can play a significant role — ;even though your efforts may not be sufficient to affect a cure.

And just how can you set about doing your part in healing yourself? In a brochure on Healing and the Mind With Bill Moyers, Rachel Naomi Remen, M.D., uses the analogy of . . .

"becoming a gardener of ourselves. We cannot grow ourselves in our garden by simple, direct volition. But we can create the conditions of growth, or the conditions of healing, by nourishing, nurturing, and tending within us that which we value and wish to help grow."

Larry LeShan, a pioneering psychotherapist in the field of cancer support, suggests in his book, "Cancer As a Turning Point," that you ask yourself a series of questions that lead to a greater understanding of what is important to you. By taking the time and effort to uncover that which you "value and wish to help grow," you will know what you need to nourish in your inner "garden."

The types of questions LeShan suggests you ask yourself are:

If you could do (or be) absolutely anything in the world that you wanted during the rest of your life, what would you truly want to do (or be)?

Under the present circumstances, what are the first steps you need to take to begin moving toward living this life?

Here are other questions for which the answers can lead you to choose the type of treatment that can most closely meet your needs as you move toward greater healing:

In general, are you happy and contented with your life? If so, why? If not, why not?

Is there something you are willing to let go of, even though it may have been important in the past?

What does "quality of life" mean to yo

What value do you place on length of life in relationship to quality of life?

What is more important to you, your opinion of yourself or what others think of you?

What is your greatest regret in life?

What is your greatest joy?

What value do you place on physical appearance?

What coping skills have you used in the past that have allowed you to get through difficult challenges?

How do you react to pain and discomfort?

How much are you willing to change your lifestyle during treatment and after treatment is over?

What has been your purpose in life?

Is there a goal you are determined to reach, if at all possible, before you die?

What decision-making process in the past has allowed you to make the best choices?

hat is it about your relationships that support and strengthen the kind of person you are or want to be?

Is there something about some of your relationships you want to hold onto at all costs?

After you've carefully gone through these questions, you will be closer to laying down a foundation for healing — ;and also closer to understanding the kind of treatment plan (or combination of therapies) you could accept wholeheartedly, or with the fewest misgivings.

Weighing the Cost/Benefit Ratio

While statistics apply to groups of people and not to you specifically, they can be of great value in helping you decide if you will embark on one plan rather than another. The likelihood that one approach will be more successful than another needs to be taken into account, together with your personal preferences, in exploring what might be called the "cost versus benefit ratio" for each treatment option.

For most people the "benefit will be the possibility they will be cured or live longer than they would if they didn't have treatment. The "cost" will not only be the financial burden, which could be considerable without insurance, but also the price you must pay in discomfort during and after treatment.

If there is a drug or treatment program that has had an almost 100% success rate in terms of survival, even though the possible side effects may be both short-term (such as an upset stomach and fatigue) and long-term (such as inability to have children or a permanent dry mouth caused by radiation to the throat), you may be willing to pay the price of investing in that treatment. A therapy with an low probably of success that will seriously compromise your quality of life may not be worth the price you have to pay.

On the other hand, if you want a minimum of side effects, you might opt for a treatment that is not considered very likely to succeed — ;although there still may be some potential for cure or long-term survival. However, if you reject a treatment because you are afraid it will be too painful, please talk with a pain specialist and remember that the fear of pain is frequently greater than the reality.

Nevertheless, you need to trust your own judgment (after talking with a number of people) and not be forced into accepting a treatment you feel you can't handle.

Believing Your Choice is the Best You Could Have Made

Imagine now that you have made your decision based on what you feel is best for you, treatment is over, and it's several years down the road. If there is no longer any sign of disease in your body, whether or not the doctors are willing to say you were "cured," you will most likely look back on the treatment you chose as having been the "right" one for you.

But what if your choice did not lead to a cure or long-term survival? Will you still be able to look back on the decision and say, "I made the best choice I knew how to make and even if something else 'might' have allowed things to turn out differently, I am satisfied with the process with which I made my choice and do not regret my decision."

Most people would like to be able to make that statement. One way you can be more likely to accept your choice — ;no matter what the outcome will be — ;is to sit down today and write out your reasons for making the choice you make. Put down the facts you know and the importance of each of those facts and their relationship to your decision. Include how you want to live your life, as well as how long you want to live.

Then, if things do not turn out quite as you hoped, you can read that paper and realize that you did the very best you could based on what you knew at the time you made the decision. Even if new information becomes available later, you will be able to see that your decision was based firmly on what you believed was most consistent with your values at the time.

© Copyright 1997, Revised 2002, Arlene Harder, MA, MFT

REINFORCING YOUR CHOICES

Finding a Treatment Coordinator

One of the best pieces of advice we can give you in terms of deciding what treatment you are willing to accept is to suggest you find a special person, such as your family doctor or another physician you can trust, who is willing to be your treatment coordinator. After you've gathered as much information as you feel you need, have the material printed out and take it to that person and ask him or her to help you sort out the various options and help you decide whether a given treatment plan is what YOU really want to do.

It isn't often that a single treatment is all that is needed. Much more frequently there are several types of treatment, with new options as your disease progresses or goes into remission. Therefore, if possible, also use that person as a coordinator of your care, since you will likely be seeing many specialists and will need someone to coordinate medications over the years. Having someone who knows your priorities and is familiar with your personal situation can be of invaluable help during those times when you are sent to yet another specialist.

As much as you may want to count on quality care from physicians and nurses (and have a right to get it), the reality is that in the current medical climate there are those who sometimes get what are called iatrogenic (or doctor-caused) complications. These result from inadequate tracking of medicine and lack of coordination of all aspects of treatment, including what you receive from complementary therapies. So it is wise for you to become an advocate for your own quality care. You can do this in part by paying careful attention to the medicines you take and by having a good relationship with your pharmacist.

How Can You Affect the Outcome of Treatment You Choose?

Once you have chosen a treatment based on what you want, what is available and what you can afford, you don't need to just sit back and wait for the treatment you have chosen to "do its job." There is increasing evidence that participation in your treatment can make a significant difference in your quality of life. It may also affect your recovery in ways we don't yet understand.

Further, attention to diet and use of such adjunctive or complementary therapies as meditation, yoga, tai chi and herbs may help mobilize a full range of inner healing resources. In doing so, you can become a stronger and healthier patient, which may allow you to better withstand stronger treatment, if that is needed.

Finally, remember that a combination of factors intertwine in the processes of both health and disease — medicine, genetics, psychological attributes, coping skills, social support, nutrition, environment and spirituality (see Five Factors Influence Recovery). Until there is better understanding of everything that causes and cures disease, there is no way to be certain what specific factors in your particular case will make the greatest difference toward recovery.

Nevertheless, you can best influence both physical recovery and inner healing by paying attention to those things which allow you to experience life to the fullest, to find pleasure in every day and to appreciate the great mystery that is every person's life.

Here are some final comments about making treatment choices.

Each day choose again to take part in treatment. Being aware that you choose to accept your treatment (even though, if given your druthers, you would rather be doing something much more fun and exciting) can give you a greater sense of control over a period in your life when there are bound to be lots of ups and downs.

Oh yes, and don't forget to take lots of deep breaths.

Revisiting your values and priorities can do more than just support the treatment plan you choose. Once you've taken time to examine your life, you may no longer be willing, as you perhaps were before your diagnosis, to live unconsciously on automatic pilot (as many of us do).

© Copyright 1997, Revised 2002, Arlene Harder, MA, MFT