Ethics of palliative surgery in patients with cancer.
BACKGROUND
Surgery is an important palliative method for patients with advanced malignant disease. In addition to concerns related to clinical decision making, various moral challenges are encountered in palliative surgery. Some of these relate to the patients and their illness, others to the surgeons, their attitudes, skills and knowledge base.


RESULTS
Pertinent moral challenges are addressed and analysed with respect to prevailing perspectives in normative ethics. The vulnerability of patients with non-curable cancer calls for moral awareness. Demands regarding sensibility and precaution in this clinical setting represent substantial challenges with regard to the 'duty to help', benevolence, respect of autonomy and proper patient information. Moreover, variations in definition of palliative surgery as well as limited scientific evidence with respect to efficacy, effectiveness and efficiency pose methodological and moral problems. Therefore, a definition of palliative surgery that addresses these issues is provided.


CONCLUSIONS
Both surgical skill and much moral sensibility are required to improve palliative care in surgical oncology. This should be taken into account not only in clinical practice but also in education and research.
Hofmann
B
B
Section for Medical Ethics, University of Oslo, Norway. b.m.hofmann@medisin.uio.no
Håheim
L L
LL
Søreide
J A
JA
D026686:Beneficence; D035843:Biomedical Research / Q000941:ethics; D004992:Ethics, Medical; D006292:Health Priorities / Q000941:ethics; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D009369:Neoplasms / Q000601:surgery*; D010166:Palliative Care / Q000941:ethics*; D010353:Patient Education as Topic / Q000941:ethics; D018570:Risk Assessment / Q000941:ethics