Medullary thyroid carcinoma: ethical issues for the surgeon.
Medullary thyroid cancer is a disease with an established genetic inheritance pattern for which evidence-based guidelines recommend genetic testing and subsequent management of affected patients and their family members. The perceived stigma of genetic testing, coupled with issues involving confidentiality and disclosure, create potential conflict and confusion. In some cases, there is a need for genetic testing and prophylactic surgery in children, augmenting the need for a judicious approach that balances respect for individual autonomy and parental rights with the best interest of the child. We provide an overview of the ethical issues facing surgeons caring for patients with familial medullary thyroid carcinoma, and recommend interventions and resources to assist in decision making in these difficult situations.
Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. shumana@mskcc.org
Andrew G
AG
Shuman
Ashok R
AR
Shaha
R Michael
RM
Tuttle
Joseph J
JJ
Fins
Luc G T
LG
Morris
D000328:Adult; D018276:Carcinoma, Medullary / Q000151:congenital; D002648:Child; D003219:Confidentiality; D003657:Decision Making; D030881:Disclosure; D004992:Ethics, Medical; D005190:Family / Q000523:psychology; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000941:ethics*; D006801:Humans; D018813:Multiple Endocrine Neoplasia Type 2a; D009386:Neoplastic Syndromes, Hereditary / Q000235:genetics* / Q000601:surgery; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000235:genetics* / Q000601:surgery; D013965:Thyroidectomy