U članku je prikazan bolesnik s uznapredovalim stadijem karcinoma prostate koji je odbio predloženi način aktivnog onkološkog, a prihvatio samo palijativno liječenje. Radilo se o 77-godišnjem bolesniku s lokalno proširenom i invazivnom (Gleason score 9) bolešću i koštanim metastazama u centralnom skeletu i oba femura. Preporuke urologa o liječenju, orhidektomiji i uzimanju antiandrogena, je odbio, kao i nastojanja obiteljskoga liječnika da ga nagovori. Prihvatiti ili ne prihvatiti bolesnikovu odluku, te razmišljanja je li se moglo učiniti više, dileme su s kojima se susreću liječnici u skrbi za ovakvog ili slične bolesnike. Zakon o zdravstvenoj zaštiti i Kodeks medicinske etike i deontologije nas obvezuju da uvažimo pravo bolesnika na prihvaćanje ili odbijanje predloženog dijagnostičkog ili terapijskog postupka Osim toga, sve je više rasprava u literaturi o učinkovitosti onkološkog liječenja pacijenata koji se nalaze u terminalnoj fazi bolesti i sve više dokaza o pogoršanju kvalitete života, najčešće uzrokovane neželjenim učincima kemoterapije, povećanim brojem hospitalizacija i drugim oblicima agresivnih intervencija u osoba koje primaju palijativnu kemoterapiju. Međutim, bez obzira na racionalnost donesenih odluka, u zdravstvenim radnicima koji rade s ovakvim bolesnicima ostaje „gorak okus“, pod većim su stresom i skloniji razvoju sindroma izgorjelosti na poslu. Stoga bi valjalo razmišljati o potrebi sustavnog ulaganja u pružanje podrške zdravstvenim radnicima koji rade s teškim bolesnicima kroz antistres treninge, odjelne sastanke, vršnjačke skupine ili Balintove grupe.This article describes the case of a patient with metastatic prostate cancer who refused recommended active oncologic treatment. The patient was a 77-year-old man, with advanced local cancer status, very high PSA level and bone metastases, to whom castration and antiadrogen therapy were recommended. In spite of the intention of his family doctor to accept the recommendations, the patient and his family remained persistent. He only accepted a palliative home care. Taking care for this patient was not an easy task for his family doctor because many dilemmas arose; to accept or not his decision, or if the medical decisions were evidence-based , have I done enough for this patient? But, from the rational point of view, family doctors should accept their patients’ decisions, because they are in accordance to the Croatian Law on Patient’s Rights and in accordance to the Doctor\u27s Ethical Code. Moreover, the patient\u27s decision seemed rational from the medical point of view. There is a lot of evidence based (EBM) literature questioning the effectiveness of chemotherapy near the end of life. But, something irrational in family doctor\u27s thoughts and feelings still remains bringing him a certain sort of stress. This was solved through discussion in peer-groups, because other methods do not exist in practice. In conclusion, it could be said that this situation is very common in health care and that further resources, human and material, should be invested in helping the health care professional to deal with the possibility of the burn-out syndrome
