Publication
Ethical dilemmas encountered by a palliative care team at a Pediatric cancer center in guatemala
Bustamante Tuchez L, Rivas S, Paz G, Valverde P, Zaidi A, Close P · Pediatric Blood and Cancer · 2018
Background/Objectives: Ethical dilemmas commonly occur around life threatening illness and are a source of distress for families and medical providers. Unidad Nacional de Oncologia Pediatrica (UNOP) is a large Pediatric cancer center that treats over 500 new patients per year. A multidisciplinary palliative care team reviews all patients with ethical issues to provide consultation and support. Design/Methods: A retrospective chart review was performed for patients evaluated between 2010 and 2017. Data was extracted from multidisciplinary team meeting notes. Common ethical themes were identified. Reviewer was a Pediatric bioethics-trained palliative physician. Results: Of X cases reviewed, 207 patients with ethical dilemmas were identified by case notes. 40% (82/207) involved decisions about withdrawing or withholding treatment in Intensive Care (most patients discussed had cerebral death, refractory shock, or non-response to cancer treatment). 25% (52/207) were decisions related to change in direction of therapy, typically de-escalation of treatment intensity. 11% (23/207) involved treatment refusal, mostly declining mutilating surgery. 18% (37/207) ethical dilemmas related to beliefs ingrained in Mayan culture. Principles of justice, non-maleficence, and patient autonomy were central to all discussions with patients. Treatment abandonment was found to have causal relationship with religious beliefs, culture, as well as poverty. Treatment modification decisions for 2 pregnant adolescents, 2 patients with substance abuse, and 6 patients who refused blood transfusions for religious reasons were noteworthy. Conclusions: Ethical dilemmas are common in Pediatric Oncology patient care. Involvement of bioethics trained professionals in the multidisciplinary care teams helps patients, families, and care providers maintain alignment with sound bioethics principles while making culturally sensitive, difficult decisions about patient care.
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.