Ethical Dilemmas in Elderly Cancer Patients: A Perspective From the Ethics of Care

摘要

Elderly cancer patients are a large and rapidly growing group of patients suffering from a range of problems including comorbidity, polypharmacy, emotional problems, functional and cognitive limitations, and a lack of social support, which require physical as well as psychosocial support. For the elderly, cancer treatment and patient experiences are far from one-size-fits-all. During the last decade, oncologists and geriatricians have begun to work together to integrate geriatric principles into oncology care. Applying geriatric principles and assessment to this older population may be helpful in decision-making by providing estimates of life expectancy, identifying vulnerability in individuals, and releasing patients' strengths, weaknesses or preferences. On the other hand, in caring for elderly cancer patients, many ethical problems can be encountered. Ethics involves more than decision-making, and in fact caring is an ethical enterprise itself. In this article an ethical approach is introduced that is especially helpful when dealing with elderly cancer patients. Two cases are discussed, first from the perspective of the traditional medical approach of principlism and subsequently from an ethics of care perspective. By adopting this latter perspective, a better view is gained of what is ethically at stake for both elderly cancer patients and their caregivers.