Bio‐ethical issues in oncology during the first wave of the COVID‐19 epidemic: A qualitative study in a French hospital

Abstract

Background Using a specific bioethical theory (=global bioethics) and method (=a posteriori), we try here to identify and evaluate the bio‐ethical issues raised by the COVID‐19 pandemic, and possible solutions, to improve the management of cancer patients at the hospital in future pandemics, before the emergence of vaccines or scientifically validated treatments. Materials & Methods Our work is based primarily on the clinical experience of three oncologists from the oncology department of Foch Hospital in France, who were on the frontline during the first wave of the epidemic. We compared their perceptions with published findings, to complete or nuance their views. Results Three bio‐ethical issues were identified, and possible solutions to these problems were evaluated: (1) scientific evidence versus lack of time → the creation of emergency multidisciplinary team meetings (MTM); (2) healthcare equality versus lack of resources → the development of telemedicine; (3) individual liberties versus risk of contamination → role of cancer patients' associations, psychologists and bioethicists. Conclusion We consider the creation of an emergency MTM, in particular, in addition to a true ethics committee with real competence in bioethics, to be a first solution that would be easy to implement in hospitals in many countries.

Good practice in medicine and biology: scientific integrity needs global bioethics

“…should be favored. In practice, at Foch Hospital, in France, we made use of this ethical theory during the COVID-19 pandemic, to study different (bio-)ethical issues in oncology [ 12 ], especially the policy concerning anti-COVID-19 vaccination for cancer patients [ 13 ]. We are working on the further conceptual and methodological development of this ethical theory in our department, with the aim, in particular, of differentiating between the study of macro-(bio-)ethical issues (eq.…”

Bioethics after the COVID-19 pandemic: More research, fewer committees?

“…21 This study was finally published in September 2022, as an original article , in the Journal of Evaluation in Clinical Practice. 22 …”

“…), but aimed to improve the management of patients suffering from cancer, in this particular context. 22 Through the use of an approach that was more micro-bioethical (i.e. at the local scale = hospital, institute, etc.)…”

“…), and delimiting our ethical theory in terms of the happiness and survival of cancer patients, oncologists, and relatives, at the scale of a single hospital, the emergency MTM appeared to be a satisfactory short-term solution for the application at the start of a similar or equivalent future health crisis. 22 …”

“…21 This study was finally published in September 2022, as an original article, in the Journal of Evaluation in Clinical Practice. 22 One of the three bioethical issues identified was the tension between a medical standard (i.e. evidence-based medicine), that had effectively become a moral one, and new medical and/or biological practices (= diagnosis, treatment, etc.…”