Friday, October 26, 2007

Cancer survival, complexity, and ethics

Soon-to-be-published research on depression and cancer survival allows us to sharpen our thinking about the link between psychology and ethics as well as the link between psychology and cancer survival.

The University of Pennsylvania study followed 1,093 patients with head and neck cancer. 645 died during the study. Analysis of the quality of life questionnaire showed no correlation between emotional status and survival.

Whether and how positive emotions affect the course of cancer has been debated in terms that are often polarized and bitter. Proponents attack the “medical model” for ignoring the patient’s capacity for self healing. Opponents attack the “happiness model” for encouraging patients to blame themselves for relapses and leading the gullible to forgo potentially effective treatment.

Reading about the Pennsylvania study led me to do a Google search on Dr. Bernie Siegel, perhaps the most famous champion of psychological healing. The search was revealing. The first entry was to “Quackwatch.” It warned against fraudulent marketing of claims of cure by psychological methods. The second was to the Premier Speakers Bureau. It extolled Dr. Siegel as an inspiring speaker, teacher, and healer.

Bernie Siegel as quack and Bernie Siegel as guru, side by side in Google. How do we handle this juxtaposition?

Good clinical ethics and good organizational ethics require skill at embracing and managing complexity. When patients with cancer are interested in “holistic” treatment programs, skillful clinicians find ways of supporting their quest for an improved emotional state while also helping them remain open to evidence based chemotherapy and radiation approaches. When organizations encounter ostensibly incompatible “good versus good” conflicts, skillful leaders find ways to help the contending parties tolerate uncertainty and explore options.

For many situations initially seen in stark either/or terms – whether with patients or within organizations – superior solutions can be found if we can eschew the pleasures of righteous certainty and learn to tolerate ambiguity. Muhammad Ali taught us this when he explained his philosophy of boxing: “float like a butterfly, sting like a bee.”

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