One of the more difficult topics to discuss concerning the ethics of healthcare is distributive justice—the fair distribution of benefits, risks, and costs.
Paul R. Helft, MD
A delirious head and neck cancer patient does not have the capacity to make treatment decisions. Can we begin palliative radiation therapy without his consent?
Should I give a patient with a carcinoma of unknown primary another dose of a study drug, since she is requesting to continue it? My reading of the trial protocol suggests no absolute restriction on giving another dose of the drug.
I was recently consulted concerning a patient in the ICU at my hospital with advanced breast cancer, but I soon realized there were much larger issues at stake. This woman is in her 50s and was diagnosed approximately 1 year ago with metastatic triple-negative breast cancer.
In a case of a patient with impaired decision-making, is the physician obligated to go through with a transplant when the transplant-related mortality would be on the order of 50%, and possibly as high as 80%?
A 40-year-old woman with no significant family history of cancer came to me for a second opinion about her widely metastatic infiltrating gastric cancer.
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?
One way of framing the ethical question in this case might be: “What are my ethical obligations to provide an anticancer therapy when I think it is unlikely to benefit the patient?” The broader clinical questions involved in this case are fundamentally the same in most patients.
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.
The family of a young woman with a brainstem glioma has been haranguing her physician to continue bevacizumab treatment despite a significant decline in her functional status. How to respond?