Facing Ethical Dilemmas in Oncology
Oncology clinicians face ethical dilemmas regarding access to care and treatments, palliative and end-of-life care, and treating vulnerable populations in today’s clinical environment.
|The following article features coverage from the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference in Anaheim, California. Click here to read more of Cancer Therapy Advisor's conference coverage.|
Oncology clinicians face ethical dilemmas regarding access to care and treatments, palliative and end-of-life care, and treating vulnerable populations in today's clinical environment.
At the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference, R. Donald Harvey, PharmD, BCOP, FCCP, FHOPA, associate professor of hematology/medical oncology and pharmacology and director of phase 1 clinical trials section at Emory University School of Medicine and Winship Cancer Institute in Atlanta, Georgia, led a discussion of ethics in oncology.1
“We can have differences fundamentally in values and goals, and those can be differences of patient vs caregiver, clinician vs patient, caregiver vs clinician, and many other scenarios that cause conflict,” said Dr Harvey.
Other sources of ethical dilemma include ineffective or incomplete communication, unanswered questions created by rapid advances in science and technology, allocation of scare resources, institutional policy, and state or federal law.
The foundation of ethics is based on the principles of autonomy, beneficence, and social justice, though autonomy is likely no longer the primary principle in oncology, according to Rebecca D. Pentz, PhD, professor of research ethics at the Winship Cancer Institute.
Though a patient has the right to refuse any treatment, he/she does not have the right to demand any treatment. “You have no duty to offer medically inappropriate treatments,” Dr Pentz said. The principle that takes priority, she said, depends on the case.
Ethical concerns are common in palliative care and include conflicts of goals, withdrawal or withholding treatment, artificial hydration and nutrition, medical futility, undertreatment of pain or other symptoms, palliative sedation, and physician-assisted death, according to Lauran Koranteng, PharmD, CPE, a clinical pharmacy specialist at Memorial Sloan Kettering Cancer Center in New York, New York.
Joyce Neumann, PhD, APRN, AOCN, BMTCN, program director of SCT/advanced practice nurse, adjuvant ethicist for the section of integrated ethics at The University of Texas MD Anderson Cancer Center in Houston, Texas, discussed vulnerable populations, which can include clinicians, particularly in regard to burnout.
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“I think we need to look to our personal organizations to look at ways that we can mitigate some of the distress we're experiencing so we stay engaged and we stay involved,” Dr Neumann said.
Read more of Cancer Therapy Advisor's coverage of the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference by visiting the conference page.
- Harvey RD, Pentz RD, Koranteng L, Neuman J. Practice panel: ethics in oncology. Lecture presented at: 13th Hematology/Oncology Pharmacy Association Annual Conference; March 29-April 1, 2017; Anaheim, CA.