Ethical decision-making on communication in palliative cancer care: a personalist approach

Abstract

Perhaps one of the main ethical dilemmas physicians face in cancer medicine is the question of truthfulness with terminally ill cancer patients. Reluctance to share the truth with the patient about his or her diagnosis and/or prognosis is frequently associated with cultural pressures. Based on two cases, the authors illustrate how ethical analysis can help in solving dilemmas related to truth disclosure to terminally ill cancer patients and their families. A personalist approach reveals that the often-adduced conflict between nonmaleficence/beneficence and autonomy with regard to truth telling originates from a narrow understanding of the concept of autonomy. This confrontation is, therefore, more apparent than real. A brief review of the main ethical systems and the results of their application to clinical decision-making follow the discussion of the cases.

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

“…For example, the individualistic portrayal promotes the ideas that the autonomous agent is supposed to be an atomistic self [29, 41, 44, 61, 62]; sovereign and unified [58, 62]; self-transparent to their individual beliefs and values [44, 53, 55, 65]; and self-interested in their strategic choices [25–27, 29, 37, 50, 53, 67]. It is not surprising, then, why some authors warned that this liberal picture is too abstract and fails to incorporate the social context [26, 32, 54]. This is particularly important for end-of-life care, which Marx and colleagues characterised as a ‘relational process’ [40].…”

“…Second, decision-making was described as not being an exclusively rational act [28, 42, 45, 52, 54, 55, 63, 65, 68, 69]. Relational theorists have highlighted the importance of emotions, imagination, and non-verbal communication, as essential elements of human decision-making [27, 28, 32, 45, 48, 52, 54, 68, 69, 73].…”

“…The third aspect relates to a failure to incorporate social reality. The importance of particular relationships, such as family, friends, and communities, was commonly neglected by individualistic theories [25, 27, 32, 37]. Many authors insisted that end-of-life decisions affect others through many consequences [25, 28, 37, 41, 48–50, 53–55, 63], and are affected by others’ concerns and opinions [25, 37, 41, 46, 50, 51, 55, 72, 73].…”

“…They affirmed that an individualistic conception of autonomy is too closely linked with Western cultural values. This aspect neglects alternative ethnocultural values, such as family harmony, filial piety, and community fealty [25, 29, 32, 38, 43, 44, 46, 51, 57, 59, 64]. These values are essential in collectivist decision-making societies [25, 37, 38, 43, 51, 60, 63].…”

“…These values are essential in collectivist decision-making societies [25, 37, 38, 43, 51, 60, 63]. Especially for end-of-life situations, the importance of truth disclosure was commented on as a culturally sensitive matter [32, 37, 51, 59]. According to ethnocentrically sensitive authors, cultural awareness is crucial from a global ethics perspective [34, 37, 38, 43, 44, 68, 69].…”