By Dr Ananya Mandal, MD
Cancer care is fraught with several ethical issues. There are dilemmas in diagnosis, extent of patient information, planning treatment and follow up. These issues often concern oncologists in their day-to-day practice.
Diagnosis and detection of cancer
Screening for cancer and the possibility of getting false positives (positive results indicating cancer when there is actually no cancer) are a big ethical issue.
There are several diagnostic and screening tests that are used to detect cancer. While early detection is useful for the patient, needless investigations and false positive results may raise the anxiety in the patient and their family unnecessarily. These may lead to severe mental agony and other ill effects on the patient as well.
Detection of a genetic risk of cancer in the patient’s immediate family members also poses a similar risk.
Extent of patient information
Once diagnosed, questions arise over the extent of information to be given to the patient regarding disease extent and possible outcome of the disease. Many patients may prefer to have the truth in black and white but some may wish to be shielded from the extent of spread of the cancer. Revelation of the cancer and its outcome to the patient has been an ethical challenge from time immemorial.
Inclusion in clinical trials for novel therapies
Cancer clinical trials need cancer patients for success. However, these novel therapies have not been tested for their safety and efficacy before and the patient needs to be aware of the risk of taking part in these clinical trials for the benefit of human kind. This inclusion is fraught with ethical issues.
Many patients may be unwilling to undergo certain treatment modalities. For example, a breast cancer patient may wish to retain her breasts and not lose them to surgery.
Some patients may refuse chemotherapy due to the fear of its severe adverse effects like hair loss, nausea and susceptibility to infections. Maintaining patient’s autonomy in the decisions on treatment is important.
Use or choice of alternative treatments like Homeopathy or Herbal treatments for cancer also needs to be addressed by physicians and oncologists
Withdrawal from active treatment
Another major ethical issue is withdrawal from active treatment. This may be the patient’s own choice or due to non-responsiveness of the cancer to therapy. Palliative care may be chosen in these cases. When to withdraw treatment is an important ethical issue.
End of life issues
"Do Not Resuscitate" orders and other end of life issues like euthanasia are ethical concerns that are highly debated
Other ethical issues
There are also ethical issues related to the patient’s personality, religion, culture, socioeconomic status, personal, and family life.
Resolving ethical issues
Most of the ethical issues need to be resolved using a high degree of sensitivity and very good communication on the part of the oncology team to address these problems properly. At any time the laws of non-maleficence (not to cause harm to the patient) and patient autonomy should be upheld.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)