Bioethics in Oncology: International Partnership, Moral Distress and Survivorship

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By François Pouliot, Ph.D., M.D., assistant professor and clinical ethicist, Department of Critical Care

The recent European Oncology Nursing Society meeting in The Hague, Netherlands, and the 6th International Conference on Clinical Ethics Consultation in Portland, Ore., were great opportunities to share experiences, build networks and receive good ideas on important issues in the field of bioethics.
International partnerships
The importance of international partnerships between institutions of the western world and emerging economies was underlined in both meetings.

The presence and contribution of Turkish nurses in The Hague was great. No surprise that MD Anderson has already developed partnerships in Turkey.

In Portland, there were more than 25 countries represented, and a large portion of the conference was allotted to international perspectives on ethics consultation in Brazil, Columbia, Chile and India. Ethics consultation was always offered in those countries on an individual basis, but currently, well-structured clinical ethics services are emerging at the clinical setting almost everywhere.

Dr. Jessica Moore and I, as representatives of MD Anderson, shared our own experiences of restructuring an ethics service. We are looking forward to upgrading our practice according to the highest standards.

Because bioethics was a creation of the West, a leadership that it continues to assume, we are called on to share what we have learned with the whole world. Access to postgraduate or fellowship programs and the organization of international conferences are examples of contributions made at the international level.
Moral distress
Moral distress among patients and caregivers is a serious issue for individuals and institutions because of its many important consequences. It is currently a hot topic.

When individuals make moral judgments as to the right course of action in a particular situation, but are unable to carry it out, they may experience moral distress and its psychosocial consequences: anxiety, anger, depression, cognitive impairment, absenteeism. To deal with the problem, emphasis must be placed on distress screening, counseling and support.

The clinical ethicist has an important role to help clarify the issues and make sure the right people are involved, while at the same time respect the boundaries between ethics consultation and therapy.
A survivorship program offers comprehensive cancer care where the physical and psychosocial impacts caused by the cancer, and/or by the aggressive therapies used to treat cancer, are addressed. With a large increase of survivors, survivorship programs are emerging in almost all major cancer centers.

In Europe, survivorship programs are still being managed in the regular clinics, but more and more patients are being transferred to specialized caregivers and teams. One of the issues is to make sure that patients do not feel abandoned by their cancer doctor or nurse.

In public-funded health care systems such as Europe, survivorship programs will impact resource allocation. The goal should then be to allow highly specialized doctors and teams to serve the patients who can benefit the most, and to make sure that other services are provided by the appropriate resources (survivorship doctors and teams).

The proceedings of the EONS Conference can be found in
The European Journal of Oncology Nursing, Vol. 14 Suppl. 1 April 2010.

Upcoming events:
Anderson Network Cancer Survivorship Conference, Omni Houston Westside, Sept. 24-25.
Moral Distress in Health Care Symposium, Coast Plaza Hotel and Suites, Vancouver, Sept. 18-19.

MD Anderson's Clinical Ethics Service (CES) helps patients, families and health professionals make difficult decisions about medical treatments and patient care. Any patient, family member or guardian, health professional or others with a legitimate interest in a patient may request a consultation. All consultations are confidential , and services are free. ECS representatives are on call 24 hours a day, 7 days a week. Call (713) 792-8775

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