Ethics Consultation in the Crucible of Terminal Cancer and Pregnancy: Autonomy, Suffering and Posthumous Wishes
Friday, October 13, 2023
3:15 PM – 4:30 PM ET
Location: Atlantic (Third Floor)
This presentation explores a case of an adolescent female patient diagnosed with terminal brain cancer who is pregnant and wishes to prolong her life with aggressive cancer treatment in order to carry her un-born to viability. Understanding and respecting the patient’s non-western cultural and religious background contributes to supporting patient’s decision. Such exceptional cases require collaborative work of multiple teams and sub-specialties all challenged by competing priorities and significant time constraints. In this scenario the ethics consultation is part of a larger medical discussion with the oncology and neurosurgical teams calculating how to proceed with radiation and surgery without doing harm to the fetus as well as attempting to add months to the patient’s pregnancy and life expectancy. The ethics team in the pediatric setting gives attention to the autonomy of the patient as a mature minor according to legislation and Supreme Court precedents. A critical ethical issue emerges regarding mental capacity of the patient given the unpredictable state of a glioblastoma and the potential for brain hemorrhaging at various stages. If the patient suffers brain injury or brain death, the question becomes should life supports be continued in order to protect the viability and health of the fetus? The educational/consultative role of the ethics team focused on defining the limits of patient autonomy, potential substitute decision makers, integrating the ethical considerations regarding suffering and as well as providing research on the ethical and legal precedents relevant to this type of situation.