Refraining from giving information on commercial options
Extreme 2: The doctor only provides information on treatment options that are approved and funded by the state and does not on his or her own initiative address treatment possibilities that require full self-payment.
An argument in favour of this line of action is that the doctor should provide the patient with information that benefits him or her, and which the patient has a real opportunity to make use of (Sections 1 and 2). Publicly funded treatment is available to all those who fulfil the medical criteria. Treatment that requires self-payment can only be of benefit if the principle of equal treatment is violated. If doctors are to take the principle of equal treatment seriously, irrespective of personal finances, they are in practice barred from offering or promoting treatment that depends on the ability to pay.
Another argument is that theoretical information on private treatment options is a waste of time if the patient cannot afford to make use of it, and time is a scarce resource in the daily life of oncologists. Discussions on limitation of treatment at the final stage of oncological patient pathways might constitute a better use of this time. Some cancer patients suffer from overtreatment and delayed initiation of palliative care. It should be considered whether a focus on good palliative care at the end of life, with information on symptom relief and care provision by the next of kin as well as other important palliative measures, ought to be given priority over formalistic information on private treatment options.
A further point could be that in Norway, we have a system for assessing and prioritising the types of treatment that we can offer, and doctors employed in the public sector have a duty of loyalty barring them from actively promoting treatments that we have not (yet) found ourselves able to prioritise. Although individual oncologists may feel a strong responsibility for helping the patient sitting before them, they have an equally great responsibility for all the patients in the waiting room and all those who are waiting for an appointment (Sections 1, 12 and the principles of fairness and equal treatment).
However, there are also arguments that speak against restricting information to the options available in the public health services: Section 3 says that 'a patient is entitled to information on his or her condition and treatment [...]. The patient shall be informed to the extent he or she wishes. Information which may be thought to be particularly difficult to bear, shall be given with caution'.
On this basis it can be argued that all information on treatment shall be communicated to the patient, including information on commercial treatment, even though it might constitute a burden for patients to be aware of a treatment that they cannot afford. On the other hand, information shall be provided 'to the extent that the patient wishes'. One therefore cannot firmly adhere to Extreme 2 if the patient on his or her own initiative expresses a wish for information on commercial options.