Nineteen speakers at the International Conference on Supportive Care--More than Medicine, which was cosponsored by WHO and held in Château Montebello, Quebec, Canada, 18-21 July 1988, presented short introductory lectures and led the Ethics Working Group's discussions on the following ethical issues relating to cancer research and the treatment of cancer patients: telling the truth; allowing to die and practice of euthanasia; clinical research; and limited resources leading to hard choices. This article presents the discussions and recommendations of this Working Group.
PIP: Ethical issues in the treatment of cancer patients was the subject of a international conference on supportive care, sponsored by the World Health Organization. Communications deficiencies between patients and doctors cause anguish and create a situation for ethical conflicts and dilemmas. Medical schools must teach the mastery of listening and communicating. In the past 10 years the use of life support systems to prolong life has been questioned by many people in many countries. Those in favor of euthanasia argue that a painless death is more humane that a slow, lingering one that may occur with the withdrawal of life support systems. Those against euthanasia say it is morally wrong, and against medical ethics, and not necessary if palliative care is available. They say if legalized, it would be abused and force people to use euthanasia when they did not wish to. Conditions under which euthanasia is acceptable have been identified by the courts in Japan. In most countries including the US and Canada active euthanasia is a criminal offence equated with murder. It is not clear what to tell patients that are invited to participate in clinical trials in cancer research. There is a conflict between raising false hopes and possible toxicity causing patients to refuse treatment. Many clinical investigators do not understand that patients need adequate information. Some countries stress therapeutic privilege and dispense with informed consent, if the doctor feels it is not in the patient's best interest. When dealing with a very ill or dying person, honesty and compassion are essential in all communications and in the presentation of medical facts.