Code of ethics american cancer society
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First, the stakes are high. Principle 10 Cancer therapy, prevention, education, and research are costly endeavors demanding conscientious stewardship; however, financial considerations should not dictate the quality of care offered to each patient. Summary Patients who decline conventional cancer therapy yet seek to continue follow-up while pursuing alternative therapy can pose an ethical challenge. Research requires activities that are anticipated to improve patient care and participants who are adequately informed about risks and benefits. In contrast, the situation described in this article is challenging on several levels. A patient forgoing adjuvant tamoxifen for ductal carcinoma in situ still has a good prognosis, and a patient forgoing disease-directed therapy for advanced breast cancer still faces incurable illness with or without therapy. J Oncol Pract. In some cases, an alternative practitioner may even request a procedure such as central intravenous catheter placement that might facilitate alternative therapy administration.
Are there ways to ethically continue to provide care and counseling to a patient while not supporting an alternative treatment plan? Prevalence and predictors of complementary therapy use in advanced-stage breast cancer patients. This article evaluates the ethical challenges that arise when an oncologist not only disagrees with a patient's choices but finds them inappropriate or dangerous and presents considerations for ongoing care that can honor the physician's obligations to the patient and society.
Complicating the situation further, the patient does have clear ongoing needs. She provides her physicians with correspondence indicating that surgery is viewed as one option, but an alternative involving herbs and supplements can restore balance to the body and prevent recurrence of her cancer.
The oncologist wants to help the young woman and is highly worried that she is placing her life unnecessarily at risk through this course of action.
If there is a known risk to the complementary therapy or a reasonable chance that it will make conventional therapy either more toxic or less effective, discontinuation of standard therapy might be considered.
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Pain medications. Her physicians are unsure of how they should proceed.
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All information must be recorded accurately and communicated responsibly. She provides her physicians with correspondence indicating that surgery is viewed as one option, but an alternative involving herbs and supplements can restore balance to the body and prevent recurrence of her cancer. The model of shared decision making stems directly from our desire to respect patient autonomy. Furthermore, the herbalist has recommended that the patient undergo a battery of laboratory tests, claiming they will help monitor her neuroendocrine terrain and optimize her herbal therapy. Semin Surg Oncol. If the primary purpose of a test or procedure is to facilitate a nonstandard plan of care that the physician feels is potentially harmful, the physician has not only the right to refuse but also an obligation to do so. Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen. Author's Disclosures of Potential Conflicts of Interest The author s indicated no potential conflicts of interest. The oncologist has the obligation at the time of initial consultation to educate the patient regarding the prognosis, options, and potential consequences of declining therapy. We commit ourselves to further progress against cancer by sharing the knowledge, skills, and ethical values that are the foundation of this institution. The medical condition in question is life threatening but curable, and it occurs in the context of a young patient with no other medical issues who achieved an excellent response to neoadjuvant chemotherapy. The situation becomes more complex if the patient selects alternative therapy and wishes to continue follow-up with the oncologist.
Although the importance of surgery was explained at initial consultation and subsequent visits, the patient now expresses her intent to forgo surgery and use natural methods to prevent the return of cancer.
based on 41 review