• A patient insists that you explore unproven alternative therapies for his metastatic colon cancer. Are you obliged to discuss these with him?
• How should you treat a squamous cell carcinoma on the vocal cord in a patient with advanced dementia, no surviving relatives, and no advance directives?
• You are convinced that all treatment options have been exhausted for a young woman with a brainstem glioma who can no longer hold her head up and is barely responsive. You recommend hospice care, but the family demands that you continue to treat her. What should you do?
Situations such as these are encountered on a fairly regular basis in most oncology practices. To help the readers of ONCOLOGY and visitors to the CancerNetwork handle the ethical dilemmas they confront in their daily practice more confidently, we are pleased to introduce a new feature: "Consultations in Ethics." This feature will present actual cases submitted by oncologists, and discussion of the ethical issues involved. The "consultation" will be provided by Dr. Paul R. Helft, director of the Charles Warren Fairbanks Center for Medical Ethics at Indiana University Health in Indianapolis and a member of ONCOLOGY’s Editorial Board. Dr. Helft is also an Associate Professor of Medicine at the Indiana University School of Medicine
The first "Consultations in Ethics" case—a discussion of whether an oncologist has an obligation to inform his patient’s employer that the patient insists on continuing to work despite being told that her ability to do her job safely will be compromised by the opiates she is receiving for pain—appears on page 871 of this issue of the journal. Along with the cases that will appear in these pages in future issues, additional cases and consultations can be found in the online version of the feature, on ONCOLOGY's web site, www.cancernetwork.com/ethics.
“Consultations in Ethics” will be an interactive feature. Arriving at a resolution of an ethical dilemma often involves discussion with others and consideration of the situation from a variety of perspectives. Thus, readers are encouraged to add their own thoughts on the cases presented in this feature by using the “Join the Conversation” box that appears at the end of the online version of each case.
In addition, we invite you, our readers, to send us cases in which the ethical issues involved have struck you as particularly thorny. If you have a case that you think would benefit from the perspective of an oncologist with special training and experience in medical ethics, you can email it to me at susan.beck@ubm.com. We will select cases for consultation that we feel are likely to be relevant and helpful to the journal's readership. Names and identifying details will be changed so as to ensure protection of privacy when the cases are published.
We hope you find "Consultations in Ethics" helpful to you in your daily practice. As always, we welcome your feedback!
Susan Beck
Executive Editor, ONCOLOGY
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
