NOTHING MORE TO BE DONE - PALLIATIVE CARE VERSUS EXPERIMENTAL-THERAPYIN ADVANCED CANCER

Patients suffering from advanced, incurable cancer often receive from their doctors proposals to enroll in a clinical trial of an experiment al therapy. Experimental therapies are increasingly perceived not as a highly problematic approach but as a near-standard way to deal with i ncurable cancer. There are, however, important differences in the diff usion of these therapies in Western countries. The large diffusion of experimental therapies for malignant disease in the United States cont rasts with the much more restricted diffusion of these therapies in th e United Kingdom. The difference between the two reflects differences in the organization of health care in these countries and distinct pat terns of the professionalization of medical oncology in America and in Britain. The high density and great autonomy of medical oncologists i n the United States encourages there the diffusion of experimental the rapies (regarded by some as expensive and inefficient); the lower dens ity of these specialists in the United Kingdom and their task as consu ltants and not primary caregivers, favors the choice of more conservat ive (for some, too conservative) treatments. Theoretically, the decisi on as to whether patients suffering from advanced, incurable cancer wi ll be steered toward an experimental therapy or toward palliative care depends on the values and beliefs of these patients and their physici ans. In practice, however, such choice does not depend exclusively on the individual's cultural background and ethical values, but is also s trongly affected by the - culturally conditioned - professional and in stitutional structure of medicine.