CONSULTATIONS IN ETHICS
Practicing oncologists regularly wrestle with a wide variety of ethical issues. If you have a case that you think would benefit from the advice of an oncologist with special training in ethics, email it to us. Cases that the Editors feel are likely to be relevant and helpful to others will be selected for consultation by Dr. Paul Helft, director of the Charles Warren Fairbanks Center for Medical Ethics.
To protect privacy, identifying details will be changed or removed when the cases are published. Disclaimer.
Don't Tell Me Anything Negative
Paul R. Helft, MD1,2,3
, May 15, 2013
I looked after one of my partner’s patients who is approaching death from advanced, refractory ovarian cancer. She asked me not to talk about anything negative with her. We can’t really make any decisions without discussing negative things. Should I just remain silent about them at her request?
Rationing Healthcare: Who's Responsible?
Elizabeth Dzeng, MD, MPH1, Thomas J. Smith, MD2
, February 15, 2013
To place responsibility for rationing chemotherapeutics on the oncologist not only increases his or her emotional burden, but it also strains the doctor-patient relationship. We should not allow oncologists to become bedside healthcare rationers simply because no one else wants to do the job.
Ethical Challenges in Oncology, Explored Through a Series of Vignettes
Laura Tenner, MD1,2,3,
Paul R. Helft, MD1,2,3
, February 15, 2013
In this article, we have chosen to focus on three ethical challenges that we believe practicing oncologists might commonly encounter with their patients. The ethical dilemmas are presented in a case-based approach in the hope of better joining the ethical theory to clinical practice.
• Rationing Healthcare: Who's Responsible?
• The Need to Individualize Advanced Cancer Care
Exploring the Interface Between Cancer and Psychiatry
Murray Krelstein, MD
, June 23, 2010
As a psychiatrist who has cancer, I have developed a deep understanding of how clinicians can help patients who are facing the complicated emotional aspects of dealing with a potentially life-threatening illness. When it comes to cancer, I have been through a lot and have learned a lot.
Giving Honest Information to Patients With Advanced Cancer Maintains Hope
Thomas J. Smith, MD1, Lindsay A. Dow, MD1, Enid Virago, M.Div.1, James Khatcheressian, MD1, Laurel J. Lyckholm, MD1, Robin Matsuyama, PhD1
, May 13, 2010
Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
Health Literacy, Communication, and Treatment Decision-Making in Older Cancer Patients
Sunil Amalraj, MD1, Chelsea Starkweather, MPH2, Christopher Nguyen, BS3, Arash Naeim, MD, PhD4
, April 13, 2009
The authors review the current trends in health literacy, patient-physician communication, and the medical treatment decision process, focusing attention on the older cancer patient population.
'Futile Care': What to Do When Your Patient Insists on Chemotherapy That Likely Won’t Help
James Khatcheressian, MD1, Sara Beth Harrington, MD2, Laurel J. Lyckholm, MD3, Thomas J. Smith, MD4
, July 1, 2008
While there is no generally accepted medical definition of "futile care," many factors may play a role in the delivery of chemotherapy to patients who are unlikely to benefit. In this review, we consider the roles of both the patient and the physician in driving the provision of "futile care" and offer practical steps the oncologist can take to avoid it.
Martin Abeloff and the Quality-of-Life Movement
Barrie Cassileth, PhD
, May 1, 2008
Integrative oncology, the synthesis of gold-standard care and evidence-based complementary modalities, deals not only with the patient’s tumor, but also with her physical and emotional needs and with the relevant cultural, scientific, and policy issues. This synthesis was one of Marty Abeloff’s main professional goals.
Cost Considerations in the Management of Cancer in the Older Patient
June M. McKoy, Md, MPH1, Karen A. Fitzner, PhD2, Beatrice J. Edwards, MD3, Motasem Alkhatib, MD4, Cara C. Tigue, BA5, Narissa J. Nonzee, BS6, Carlos R. Bolden, BS7, Charles L. Bennett, MD, PhD, MPP8
, June 1, 2007
This paper provides an overview of several prominent articles and empirical studies on supportive care and cancer-related costs faced by older cancer patients. It focuses primarily on individuals 65 years of age and over and reviews several types of cancer.
Reproductive Issues in the Gynecologic Cancer Patient
Jeanne Carter, PhD1, Sharyn Lewin, MD2, Nadeem Abu-Rustum, MD3, Yukio Sonoda, MD4
, April 30, 2007
For women with a gynecologic cancer, reproductive concerns may vary not only by site of disease but also by the presentation and manifestation of the disease. Gynecologic cancer can present before childbearing has been started or completed, during pregnancy, or can even arise out of pregnancy.
Disparities in Cancer Care: Challenges and Solutions
Derek Raghavan, MD, PhD
, April 1, 2007
There is an increased incidence of cancer in minority populations, accompanied by reduced survival. This review will address specific areas of disparity in cancer care, including prevention, diagnosis, treatment, and outcomes, and will consider steps toward resolving these issues.
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ETHICS AND ONCOLOGY BLOG
Ethics and Oncology is a new blog for CancerNetwork written by Paul R. Helft, MD, director at the Fairbanks Center for Medical Ethics and associate professor of medicine at Indiana University School of Medicine.
Ethics of Cost Containment for Cancer Therapies
Arthur Caplan, PhD1
, August 23, 2012
The cost of cancer treatment has at least doubled since 1987 and there does not appear to be any hint that cancer care costs will decline. In this podcast we discuss the reasons for the increase in costs, as well as the ethics of cancer care cost containment.
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