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Is the Treatment Beneficial, Experimental, or Futile?

Published online by Cambridge University Press:  29 July 2009

Lawrence J. Schneiderman  and
Nancy S. Jecker
Lawrence J. Schneiderman
Affiliation:
A professor in the Departments of Family and Preventive Medicine and Medicine, School of Medicine, University of California, San Diego.
Nancy S. Jecker
Affiliation:
The book review editor for CQ, associate professor in the Department of Medical History and Ethics, Department of Philosophy, and School of Law at the University of Washington, Seattle.
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Extract

D.T. a 35-year-old woman, was found to have breast cancer. At the time of mastectomy axillary lymph nodes were positive and the cancer was classified as adenocarcinoma, grade 4. The patient underwent conventional chemotherapy. When it became apparent the disease was metastatic, the patient's oncologist contacted a well-known cancer center regarding the possibility of treating the patient with high dose chemotherapy and autologous bone marrow transplantation (HDC/ABMT). The patient's health insurance provider informed the patient, however, that the treatment—estimated to cost in the range of $150,000–200,000—was “considered experimental or research in nature” and therefore was not included in coverage. D.T. did not pursue this further. Approximately 2 years later, cancer was detected in the patient's spine. This time she applied to another well-known cancer center for HDC/ABMT. The cancer center agreed to accept her on the condition of proof of ability to pay for the treatment. Again her insurer refused coverage on the same grounds as before. D.T. found another source for the money, underwent treatment, then sued the insurance carrier. She sought a declaratory judgment that the treatment was covered under the insurance policy. The court ruled in favor of D.T. finding the contract phrase “considered experimental” ambiguous.

Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 5 , Issue 2 , Spring 1996 , pp. 248 - 256
Copyright
Copyright © Cambridge University Press 1996

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References

Notes

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