Academic journal article Iranian Journal of Public Health

Ethical Issues in the End of Life Care for Cancer Patients in Iran

Academic journal article Iranian Journal of Public Health

Ethical Issues in the End of Life Care for Cancer Patients in Iran

Article excerpt

Abstract

Background: In the recent years, advances in medical technologies for end stage cancer patients' care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.

Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.

Results: During the process of analysis, three main themes emerged about ethical dilemmas in end of life care for advanced cancer patients: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.

Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians' communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.

Keywords: End-of-life care, Cancer, Ethics, Iran

Introduction

Cancer is the important cause of death in many countries (1), including Iran (2). In fact, cancer, being a life-threatening disease, makes the inevita-ble need for the implementation of an effective end-of-life care strategy in health care services more than ever (3). Physicians should consider the patients' best interests (4); moreover, the treat-ment they choose should be beneficial to the pa-tients and does no more harm. Besides, the treat-ment should be selected on the basis of the pa-tients and their families' views on end-of-life care and financial costs of terminal care (5). Therefore, on the basis of patients' views and conditions, oncologists sometimes decide to continue curative cancer therapy for terminal patient to improve the survival rate or recommend palliative care to improve the patients' quality of life (6, 7). Oncologists can fairly decide on end-of-life provided that they know patients' and their families' values and preferences (8), and can communicate with them honestly (9). Many physicians avoid informing patients of their survival chance, because they believe that discussing this issue may diminish patients' hope (10). In addition, health care costs are high in many parts of the world and financial discussions on the cost of treatments and care of end stage cancer patients can be of paramount importance (11). Consequently, considering differences of health care services in various cultural backgrounds and social structures, the professionals in service providing face with numerous ethical problems for decision-making (12,13).

Many studies have discussed ethical problems in decision making on end-of-life care (12). In one study, the authors believed that physicians face different ethical problems, the most important of which being uncertainty about treatment, prognosis, quality of life and external factors such as economic and legal issues as well as work environment (14). Another study showed several factors which included patients' characteristics and illness factors, health care provider and health care system agents (15). In another study, researchers reported a considerable difference in Russian, Swedish and German physicians' approach in terms of end-of-life treatment decisions which relies on a large variety on socio-cultural context (16). …

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