Ethical issues in Cancer Treatments.

1. Ethical issues in Cancer Treatments.

2. 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.

3. Ethical Principles • Autonomy • Beneficence • Non maleficence • Justice

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

5. For a consent to be valid it must: Be given by a competent person. Be given voluntarily. Be informed.

6. 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.

7. 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.”

8. 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”

9. 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”

10. 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.’

11. Capacity and Consent. • Re C • Re MB

12. 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

13. End of Life Issues.

14. 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…

15. R v Carr “ However gravely ill a man may be…he 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 man’s 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.”

16. 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.

17. 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.

19. 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.

20. Bland.

21. “ 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.