Ethical Considerations in the Treatment of Head and Neck Cancer

David P. Schenck, PhD

Disclosures

Cancer Control. 2002;9(5) 

In This Article

Conclusions

Treatment of head and neck cancer raises interesting and compelling issues in terms of ethical decision making. These issues surface due to not only the disfigurement and dysfunction that often occur with treatment, but also the particularly intimate nature of that part of the body. Disfigurement and dysfunction are problematic because of concerns for cosmesis (personal appearance), and they also represent threats to the person or to personal identity. This is exacerbated because both the disease and therapeutic attempts at healing it are invasive of intimate body parts that are at least symbolically the site of much of the person's identity. These factors must be considered in addressing ethical issues in head and neck cancer.

In the treatment of head and neck cancer patients, an approach that includes the application of the established principles of biomedical ethics, a nuanced view of what the principles mean in a particular case, and a careful balancing of these principles against one another in determining which should take precedence in a given case remains inadequate. This approach is inadequate because, while we may arrive at an ethically appropriate position, it will be largely in terms of abstract principles. A careful and purposeful inclusion of the virtues is necessary to restore the focus on the physician-patient relationship, to guarantee the humane aspects of that relationship to the extent possible, and to develop and strengthen the character of the physician in this specialty dealing so intimately with critical elements in the nature of the person. In that way,we not only help to ensure that the physician-patient relationship is not merely an impersonal, albeit professional, one where the two parties are seen largely as autonomous equals,but we also reinforce the concepts of caring and responsibility that have always been at the foundation of a philosophy of medicine.[23,28] Nonetheless, considerations such as these will also bring us to a re-examination of some of the "sacred cows" of biomedical ethics as they are often applied today. Questioning a concept such as autonomy may raise the specter of a slippery slope, but that is a worthy risk in trying to assure ourselves that it is not being invoked reflexively because it is the "ethical" thing to do. Bioethical decision making through a process that includes thoughtful integration of virtues with principles is one way to do that. It is also one way to respond to Conley's call to ethics and character of more than 20 years ago.

This article was originally certified for CME credit. For accreditation details, contact the publisher. (link to http://www.moffitt.usf.edu/pubs/ccj/ H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. Telephone: (813) 632-1349. Fax: (813) 903-4950. Email: ccjournal@moffitt.usf.edu. Cancer Control is included in Index Medicus/MEDLINE and EMBASE/Excerpta Medica.)

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