A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy

Abstract

The authors describe a clinically comprehensive ethical framework for addressing the challenges of managing cancer during pregnancy. The framework is based on the ethical principles of beneficence and respect for autonomy and the concept of the fetus as a patient.

Ethical dilemmas in the management of tumor-stage mycosis fungoides in a pregnant patient

“…1 Non-Hodgkin lymphoma, as a group, represents a small fraction of cases, with an incidence of one to five 100,000 pregnancies. 2 Of these, mycosis fungoides (MF) is very uncommon, with only rare case reports in the literature.…”

“…However, incongruent obligations, when treatments reduce the woman's risk, while at the same time increase the risks to the fetus, complicate decision-making. 1 Can we articulate a sound ethical foundation that addresses treatment options in pregnant cancer patients?…”

Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature

“…Third, the principle of beneficence demands actions that specifically benefit the patient or that provide a greater balance of benefit than harm. 56,57 And fourth and final, the principle of nonmaleficence requires interventions that may result in harm to be minimized.…”

“…In view of the uncertain effects of cancer therapy on the fetus, the mother should be provided with three treatment options: (1) decline pregnancy termination, start therapy with close fetal monitoring and reconsider termination if significant fetal side effects are detected during the previable period, (2) electively terminate pregnancy before the start of therapy, or (3) delay treatment until fetal lung maturity to allow elective premature delivery before starting chemotherapy. 57 The last option does not apply to aggressive malignancies such as ALL and advanced-stage lymphoblastic lymphoma for which even a brief delay may pose a high risk of mortality to both mother and fetus.…”

The Cornell University Experience

“…Our research has therefore addressed a wide range of topics in clinical obstetrics and gynecology including the limits of viability [67], mental health and pregnancy [68][69][70][71][72][73][74][75][76], cesarean delivery [77,78], patient's refusals of medically indicated management [29,35,38], assisted reproductive technology [79,80], obstetric anesthesia [81], cancer during pregnancy [82,83], HIV infection [84], issues in gynecology [85,86], the language that should be used in decision making with patients [87], advance directives [29,82,83] and professional issues [88].…”