By Johnna Wellesley & Emma Tumilty
The suspension of Justin Stebbing has ended and sparked renewed discussion in the media and medical community about the fairness of his case. While criticism of the GMC in general is ongoing and vociferous, a closer look at what was at stake here and what the backlash to it may reveal about patient care is worthwhile.
Clare Dyer recently acknowledged the end of oncologist Justin Stebbing’s suspension and described his case. The Medical Practitioners Tribunal Service (MPTS) suspended Stebbing for misconduct. Stebbing was a highly esteemed oncology consultant with a dynamic reputation for innovative clinical practice and pioneering cancer research. Stebbing faced 36 counts of failing to provide good clinical care to 12 patients over a 3-year period. The nature of the allegations against him primarily focused on inappropriate treatment of patients with advanced cancer, misrepresenting and overstating the benefits of certain treatments, and prescribing care that was deemed futile by his colleagues. The majority of patients (11/12) died within six weeks of receiving his directed treatment (some within days). Initially, Stebbing denied all complaints against him, but as the panel undertook deliberations, he admitted to 30 of the 36 charges. He was subsequently found guilty of an additional three.
Many within the medical community lent staunch support to Stebbing, claiming that patients are entitled to seek aggressive treatments and that his methods brought hope and time for patients and families. To his supporters, the involvement of the General Medical Council (GMC) was a bureaucratic waste of time, resources, and an unwarranted interference. We believe this is a mischaracterization of what Stebbing was suspended for. The principle of informed consent is at the heart of these complaints. Stebbing himself has since admitted, “I should not have treated any of these individuals; they were too sick to be treated.”
Having difficult conversations with patients is fundamental to being an oncologist providing patient-centered care. Those facing a poor prognosis rely on clinical expertise to help guide and inform their care and life choices, and to avoid unnecessary suffering. Not engaging in candid conversations about the benefits (or lack thereof) of certain options does a disservice to patients and denies them the ability to live their remaining time in line with their values and wishes. Choices, about how they would want to spend their limited time with loved ones, conversations they may have wanted to have, had they known, comforts they may have chosen if their situation was clear, are lost to them by providing false hope. Encouraging false hope undermines informed consent and is a morally blameworthy action in that it causes others to act on misinformation that one knows to be false.
Oncology is not always life-saving work; sometimes it is the messy, difficult work of helping people make hard decisions at the end of their lives. Stebbing, in these 12 cases at least, was shown not to engage in needed difficult conversations causing harm to his patients, their loved ones, his colleagues, and the system he worked in. Despite what might be excellent care of other patients in other situations, his care of at least these identified patients was lacking.
People accessing healthcare are fully entitled to seek out diagnostic and treatment opinions that support their values and preferences. This necessarily extends to providers with whom they relate and share confidence. The media uproar and support from the medical community regarding Stebbing’s suspension continues to side step two key elements—the real harms experienced by these patients and their families, and Stebbing’s own acceptance of wrongdoing. “I am very remorseful about my behaviour related to dishonesty, which has the potential to undermine the foundations of the medical professional and to erode the trust of both the public and patients in general.”
Criticism of the GMC’s involvement in this case falsely suggests that regulatory interference will limit patient autonomy and/or dictate treatment recommendations. Rather, this matter demonstrates the importance of exercising diligence in helping patients to reach decisions that are consistent with good clinical care and their values. The GMC’s actions uphold the principles of medical ethics which guide providers in their clinical judgement, inculcate the virtues of the profession of medicine, and ensure patients and their families are effectively informed and supported in their decision-making. The patient-physician encounter inherently entails vulnerability which is only heightened in high-stakes situations such as end of life care. The MPTS clearly demonstrated the ways in which paternalism can lead to poor decisional outcomes and is profoundly detrimental to patient care, e.g., overriding patient’s wishes in the ITU.
Though Stebbing claims to have only the best interests of his patients in mind, this case and the surrounding discourse in the medical community pose lingering questions about the definitional clarity of best interests, its relationship to shared decision-making, and the operationalization of realistic hope in the clinical encounter.
Authors: Johnna Wellesley & Emma Tumilty
Affiliation: University of Texas Medical Branch
Competing interests: None declared