Ethical issues in Cancer Treatments'

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Ethical issues in Cancer Treatments.
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Aims
Explore the legal, ethical and professional
issues associated with treating the cancer
patient. At the end of the session the learner
will 1. Apply ethical concepts to a variety of
situations involving the cancer patient. 2.
Analyse the ethical and legal issues involved in
gaining consent for treatment or procedures. 3
Apply legal and ethical theory to the patient
nearing the end of their life in consideration of
the nurses role.
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Ethical Principles
Autonomy Beneficence Non maleficence Justice
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Importance of consent.

• Legal defense.
• Respect for patient autonomy.
• Individualistic care.
• Quality of care.
• Accountability.

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For a consent to be valid it must Be given by a
competent person. Be given voluntarily. Be
informed.
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Sidaway v Bethlam Royal Hospital (1985 AC 871
(1985) 1 All ER 643 2WLR 840. A patient
undergoing surgery on her spinal column was
warned of the risk of a root nerve being
disturbed during surgery and the possible
consequences of doing so, (the risk was estimated
to be less than 2) but not of the risk of damage
to her spinal cord, (estimated to be less than
1). Following surgery she was severely disabled
and sued for lack of information, which had
precluded her from being able to give a real
consent. Her action failed when the Bolam test
was applied.
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Sidaway Lord Bridge- A judge might in certain
circumstances, come to the conclusion that the
disclosure of a particular risk was so obviously
necessary to an informed choice on the part of
the patient that no reasonably prudent medical
man would fail to make it. . A decision what
degree of disclosure of risk is best calculated
to assist a particular patient to make a rational
choice as to whether or not to undergo a
particular treatment must primarily be a matter
of clinical judgement.
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Sidaway Lord Templeman. the court must
decide whether the information afforded the
patient was sufficient to alert the patient to
the possibility of serious harm of the kind in
fact suffered There is no doubt that a doctor
ought to draw the attention of a patient to a
danger which may be special in kind or magnitude
or special to the patient
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Sidaway Lord Templeman. the court must
decide whether the information afforded the
patient was sufficient to alert the patient to
the possibility of serious harm of the kind in
fact suffered There is no doubt that a doctor
ought to draw the attention of a patient to a
danger which may be special in kind or magnitude
or special to the patient
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Bolam principle A doctor is not negligent if
he acts in accordance with a practice accepted at
the time as proper by a reasonable body of
medical opinion, even though other doctors adopt
a different practice.
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• Capacity and Consent.
• Re C
• Re MB

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New Guidance. Department of Health, (2001),
Reference Guide to Consent for Examination or
Treatment. Department of Health (2001) 12 key
points on consent the law in England
http//www.doh.gov.uk
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End of Life Issues.
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Suicide Act 1961 Section 2 (1) A person who
aids, abets, counsels or procures the suicide of
another, or an attempt by another to commit
suicide, shall be liable on conviction on
indictment to imprisonment for a term not
exceeding fourteen years
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R v Carr However gravely ill a man may behe
is entitled in our law to every hour that god
has granted him. That hour or hours may be the
most precious and most important hours of a mans
life. There may be business to transact, gifts to
be given, forgiveness to be made, 101 bits of
unfinished business which have to be concluded.
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Some Acts are lawful even if they hasten
death Dr Bodkin Adams treated an 81 year old
lady who had had a stroke with increasing amounts
of opiates, she subsequently died leaving Dr
Adams to inherit a Rolls Royce car amongst other
goods. R v Bodkin Adams (1957) Crim LR 365.
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While the deliberate unlawful administration of a
drug to end a persons life may lead to
prosecution under section 23 of the Offences
Against the Person Act of 1861, Bodkin Adams
confirmed that a doctor is entitled to
relieve pain and suffering even if the measures
he takes may incidentally shorten life by hours
or perhaps even longer Devlin J in R v Bodkin
Adams.
18
Re B. A baby girl with Downs Syndrome was also
suffering from an intestinal blockage. The
parents of the baby took the view that it was
best for the child if she did not receive
treatment and was left to die within a few days.
If the operation to remove the blockage was
successful the baby could expect to live the
normal life expectancy of a person with Downs
Syndrome.
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Lord Templeman in the court of appeal summed up
what he saw as the responsibility of the court
.to decide whether the life of the child is
demonstrably to be so awful that in effect the
child must be condemned to die. The court
authorised the treatment of baby B.
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Bland.
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• the question is not whether it is in the
  patients best interest that he should die. The
  question is whether it is in the best interest of
  the patient that his life should be prolonged by
  this form of medical treatment or care
• Lord Goff.