Ethical Dilemmas during Treatment
In the cancer care the healthcare providers receive proper training so that they can assist the patients and evaluate the condition of the patients in choosing the proper evidence based practice that will maximize the quality of health. However, it has been seen that sometimes situation arise that require the care givers to confront various options related to the goals of care, resource utilization, communication that goes beyond the lines of clinical management. Thus, in such situations the medical ethics emphasizes on the evaluation of the right path in relation to the moral justification of the choosing the right path, evaluation of the responsibilities of the clinicians towards the positive outcomes, identification of the principles at stake (Lazzarin, Biondi & Di Mauro, 2012). This study will be based on the ethical issues in cancer care.
Thesis statement- Throughout the continuum of cancer care there are ethical issues that occur during the treatment process, clinical trials, maintenance therapy and disease recurrence. Although the treatment process proves to be beneficial for some of the patients, but it has scope for ethical issues in the entire that can be disastrous both from the perspective of the patient and the family members.
The major and the most common areas where the healthcare providers face the ethical dilemmas during their practice are tri-directional. The first major issue is the treatment at the ethical issue at the time of the treatment, ethical issues during the application of the of maintenance therapy and the third major ethical issue is the recurrence of the disease (Peppercorn, 2012).
Telling truth- Improper communication between the patient and the care provider leads to anguish among the patient and this further elevates suffering. This anguish and confusion often leads to ethical dilemmas and ethical conflicts. A majority of the ethical issues arise due to the improper communication between the care giver and the patient and the situation worsens when the two people do not know each other. If the decisions regarding the procedure of cancer is take by people that understand each other, then there is a big chance of avoiding the ethical conflicts (Ling, Yu & Guo, 2017). there are occurrences of improper communication regarding the patient preferences and it affects the patient-caregiver relationship negatively. It has been seen that both the family members and the patient has differing preferences and the amount of the information discussed also make an impact on the decision making. There is a tendency among the care giver to avoid discussion which may upset the patient and the family members (Pavlish et al., 2014). This a proper example of ethical dilemma in which the care giver is unwilling to discuss on the preferences and the goals of the patient and the family members. Additionally, the discussions on the preferences and the prognosis are often see to be addressed on the later part of illness and this crisis often leads to lack of proper intervention. Studies have shown that care givers must share the data persistently so that the patients can expect frank discussions on the goals of care and prognosis. The proper way of conversation has the capability to alter the course of the care and it facilitates the elevated emphasis on the palliative care. It is sometimes not possible to conduct realistic discussions on prognosis and because there is a question on respecting and evaluating the preferences and of the patients regarding the treatment procedures. However, failure to conduct a proper discussion can lead to difficult situations in the later part of the care (Ahmed & Ali, 2013).
Improper Communication
Euthanasia- it has been accepted in various countries that sustaining or prolonging the life of patient with the artificial life support. This is often not considered as the proper thing to do. However, this view is not acceptable for the majority of the care givers, family members and he patients that are more than willing to die rather than suffering from the cancer ailment. It has been widely accepted that the patients must be allowed to die with dignity. This procedure is followed either by discontinuing or disallowing the treatment therapy (chemotherapy) from the patient, even taking away the assisted hydration and respiratory support and surgery. People that support the active administration of euthanasia says that it is the most effective way of painless death and is similar to taking away of the life support systems. However, those that do not agree with the idea argue that active euthanasia is not morally right and this is also the basic principles of medical ethics (Daher, 2013).
Low chances of cure- the decision of whether to provide the chemotherapy to the patients when the chances is especially low. In certain cases of breast cancer, it has been seen that the radiation therapy might not be able to cure the cancer and the chances are as low as 15 percent. Thus, it becomes difficult to whether the morbidity or the deformity is acceptable. The decision also tends to become difficult for the care giver and the patient and this leads to the increased occurrences of ethical issues (Wiener et al., 2015).
Patients participating in clinical research- it has been seen that the patients participating in clinical research often turns out to be beneficial for the patient and is also considered to be the best treatment facility. However, question arises whether there are several situations is clinical investigations where the research is not conceived entirely and this leads to serious implications for the participants. It has been seen that patients are asked to participate in researches where the scenarios are very trivial and the patients did not much from the experiments. There are studies that confirmed that the patients that participated in such studies have received any benefits and the conditions of the control patients even turned out to be disastrous (Weeks et al., 2012).
Search for the new and effective treatments- There are certain cancer cases where there is no known care and it has led to the increase in clinical researches that include the such cancer patients. In majority of the cases it has been noticed that an effective treatment strategy is not known and the patients readily agree to participate in the curative therapy. This type of treatment is carried in patient for whom the prognosis is properly known. The knowledge of the prognosis often leads to knowing the end result and probably the outcome of the treatment procedure. In such cases ethical issues arise and it becomes extremely difficult to involve the patients into the treatment procedures (Bertier et al., 2016).
Euthanasia
Search for the new treatment procedures- the drugs that are new and the effects are poorly known, in such conditions the effect and the end result of the treatment procedure is not known. In such cases involving a patient that do not have the hopes of recovery or improvement. In such cases involving the patients into the study will be entirely a voluntary act. Thus, the side effects of the drug must be communicated to the patients. However, such processes are not seen during the process of treatment and this leads to ethical issues and dilemmas (Kim & Prasad, 2015).
Cancer recurrence can be described as the recurrence of cancer even after the treatment is done. The recurrence of cancer is evident by the fact that it shows on the place where it has previously occurred. The recurrence of cancer can be described as a logical expression due to the tendency of the cancer cells and the certain type of the cancer like breast cancer that can recur depending on the type of the treatment. The recurrence of the cancer in the same place can lead to an ethical issue due to the fact that proper follow up plan is not maintained or the cancer therapy was not performed properly. The recurrence of cancer questions that very base of the treatment procedure and the way it was proceeded in the past. This even questions the diagnostics and the way it was carried out (Simard et al., 2013).
Conclusion
From the above discussion it can be concluded that the major and the most common areas where the healthcare providers face the ethical dilemmas during their practice are tri-directional. The first major issue is the treatment at the ethical issue at the time of the treatment, ethical issues during the application of the of maintenance therapy and the third major ethical issue is the recurrence of the disease. The report emphasized on the continuum of cancer care and the ethical issues that occur during the treatment process, clinical trials, maintenance therapy and disease recurrence. Although the treatment process proves to be beneficial for some of the patients, but it has scope for ethical issues in the entire that can be disastrous both from the perspective of the patient and the family members.
References
Ahmed, Y., & Ali, T. (2013). End of life ethics in cancer patients: Conflicts and dilemmas. International Journal of Medical Research, 1(2), 7-12.
Bertier, G., Carrot-Zhang, J., Ragoussis, V., & Joly, Y. (2016). Integrating precision cancer medicine into healthcare—policy, practice, and research challenges. Genome medicine, 8(1), 108.
Daher, M. (2013). Ethical issues in the geriatric patient with advanced cancer ‘living to the end’. Annals of oncology, 24(suppl_7), vii55-vii58.
Kim, C., & Prasad, V. (2015). Cancer drugs approved on the basis of a surrogate end point and subsequent overall survival: an analysis of 5 years of US Food and Drug Administration approvals. JAMA internal medicine, 175(12), 1992-1994.
Lazzarin, M., Biondi, A., & Di Mauro, S. (2012). Moral distress in nurses in oncology and haematology units. Nursing Ethics, 19(2), 183-195.
Ling, D. L., Yu, H. J., & Guo, H. L. (2017). Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China. Nursing ethics, 0969733017739783.
Pavlish, C., Brown-Saltzman, K., Jakel, P., & Fine, A. (2014). The nature of ethical conflicts and the meaning of moral community in oncology practice. In Oncology Nursing Forum (Vol. 41, No. 2).
Peppercorn, J. (2012). Ethics of ongoing cancer care for patients making risky decisions. Journal of oncology practice, 8(5), e111-e113.
Simard, S., Thewes, B., Humphris, G., Dixon, M., Hayden, C., Mireskandari, S., & Ozakinci, G. (2013). Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. Journal of Cancer Survivorship, 7(3), 300-322.
Weeks, J. C., Catalano, P. J., Cronin, A., Finkelman, M. D., Mack, J. W., Keating, N. L., & Schrag, D. (2012). Patients’ expectations about effects of chemotherapy for advanced cancer. New England Journal of Medicine, 367(17), 1616-1625.
Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical oncology in adolescents and young adults, 5, 1.
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