Beth, a forty-four-year-old divorced mother of two teenagers has metastatic breast cancer. For two years she has undergone two courses of chemotherapy with radiation which appears to have slowed the progress of the cancer. But during her last visit to her oncologist, she is told that the symptoms are recurring and the metastases have appeared in the lungs. The oncologist suggests she undergo autologous stem cell transplantation. Toxicity of this treatment is very high. Treatment-related mortality varies, but is likely to be at least 25%. Failure of stem cells (and bone marrow) to take occurs in 5-10% of cases. Recurrence of breast cancer following treatment occurs in 30-50% of survivors. There are a number of other serious side effects of treatment including sterility, cataracts, and secondary cancers. The cost of the procedure is $75,000. When Beth hears that her insurer will not pay for the procedure and that the medical center will only perform this procedure on women if the patient’s third-party payor agrees to cover it, Beth asks the ethics committee to review the hospital’s institutional policy.
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