Ethicist defends suspended doctor in Prince George

A leading medical ethicist is defending the actions of a Prince George oncologist who was suspended for providing an experimental vaccine to a dying cancer patient, daughter of former federal Conservative house leader Jay Hill.

"He was doing the best he could, in good conscience, for his patient," said Bernard Dickens, professor emeritus of Health Law and Policy at the University of Toronto.

The case has sparked a furor in Prince George, where some of Dr. Suresh Katakkar's former patients have rallied to his defence and Mr. Hill, an MP for 17 years, has been particularly outspoken defending the oncologist's unorthodox treatment of his 33-year old daughter, Holly, who subsequently died.

Dr. Katakkar resigned his practice last month, after the BC Cancer Agency suspended him with pay and began looking into his care of other patients.

The controversy also highlights the dilemma physicians face when a patient is desperate for treatment, however unproven, that might prolong his or her life.

Ethicists are divided on the morality of providing unapproved, slim-hope medicine to terminally ill patients, but Prof. Dickens, for one, questioned whether Dr. Katakkar should have been suspended for what he did.

"If doctors are misled by compassion, then perhaps they ought to be tolerated for their compassion and excused for their mistakes, unless they are totally irresponsible," he said.

"He didn't keep to the rules, but when there is no alternative, then simple, therapeutic innovation can be tolerated, even when it is proven that it is not effective."

Prof. Dickens likened the situation to the early days of the AIDS epidemic, when HIV patie nts pleaded with doctors for any treatment, no matter how experimental, that might prolong their lives. "The medical system accepted that," he said.

At the same time, however, the BC Cancer Agency says it now has "multiple issues of concern" related to Dr. Katakkar's practice, beyond the initial vaccine incident.

The current investigation is unprecedented in scope for the BCCA, involving an audit of all 300 patient files left by Dr. Katakkar, formerly chief oncologist at the BC Cancer Agency Centre for the North.

"Major concerns were brought to our attention, and we decided they required investigation," said BCCA vice-president Dr. Charles Blanke. He noted that the suspension of Dr. Katakkar is an "extraordinarily rare" move by the agency.

"We would never do that lightly....[But] patient safety is really our primary concern. We will do anything to safeguard that."

Dr. Blanke declined to be specific about the agency's worries. "This is a major endeavour, a serious complex investigation." Patients are being contacted when warranted, he added.

Although the BCCA has a special emergency committee that can approve treatment outside practice guidelines within 48 hours, Dr. Katakkar did not seek approval from the agency for the vaccine. He said it would have taken too long for him to prepare his submission.

The vaccine contained Ms. Hill's own fluids loaded with cancer cells. Her husband injected it three times a week, while she was undergoing special chemotherapy, also not sanctioned by the BCCA.

Dr. Katakkar could not be reached for comment, but in a long e-mail to his patients, he said Ms. Hill, who had stomach cancer, responded well to the treatment, but then succumbed to an infection.

He used a similar vaccine once before in the early 1990s. He said he explained the chances of it succeeding to Ms. Hill and her family. They agreed to the treatment.

"I am a doctor first and giving hope to my patients in a dire situation is my moral obligation," Dr. Katakkar told his patients. "That's what I did."

Other ethicists disagreed with Prof. Dickens. They said it is wrong for doctors to hold out false hope to their patients, or provide treatment outside practice guidelines without seeking clearance.

"Otherwise, you get a kind of chaos or anarchy, and more patients are likely to be harmed than helped," said Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba.

Prof. Schafer also criticized Dr. Katakkar's contention that he had a moral obligation to provide hope to his patient. "Boy, do I think that's wrong-headed," he said. "In fact, a doctor's moral obligation is not to give a patient false hope."

Tim Caulfield, Senior Health Scholar at the University of Alberta, said the Hill case underscores how difficult these decisions are.

"When you're dying, your tolerance for risk is incredibly high, and you're willing to try anything," Prof. Caulfield said. "But in the end, you've got to lean on what the evidence says, an evidence-based approach."

Jay Hill, meanwhile, continues to strongly support Dr. Katakkar's actions.

The treatment cost nothing, he said in an interview. "And he loses his job and his reputation. I'd like somebody to explain to me how that's fair. What was the harm?"

Dr. Blanke of the BCCA, an oncologist himself who has had family members with cancer, said he understands how difficult it is for the public to grasp that offering false hope is wrong, as is suggesting last-gasp treatment that is not an active therapy.

"Telling a patient you have no active therapy to offer is one of the hardest things we do, but it is also one of most important."