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Editorial: Ethical Principles in Cancer Care

Issue: Vol.4, No.2 - April 2005

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Article Type: Editorial

Prof. Sigridur Halldorsdottir PhD (MD. Dr.)

Among the foremost ethical principles in cancer care, and in health care in general, are non-maleficence (do no harm), and beneficence (do good).  This refers not only to the therapy that is being given, but also to the human encounters between patients and health professionals.  In light of this, it is alarming that cancer patients sometimes report disempowering encounters with health professionals- encounters, which left them feeling disheartened and down-broken. Human suffering is often the hidden dimension of illness and in the case of cancer patients the suffering is also existential.  This makes the cancer patient more vulnerable and sensitive and in greater need for caring and compassion than before the invasion of the cancer.  It also means that uncaring in its many different forms can have deeper effect on them than the average patient.Unfortunately, hospitals can be very alienating and dehumanizing places.  This means that health professionals have to make a special effort in humanizing the hospital stay of the patient.  If they do not, patients can lose their sense that they matter to someone and that their recovery is important and may feel processed by a system that can be both cold and unkind. In Iceland we have a common saying: “Be careful in the presence of a human soul”.  This old wisdom has been supported by studies, which have shown the links between emotions, the brain, the immense system and health through the new interdisciplinary science of psycho-neuroimmunology.  Through this highly complex area of research we know that chronic stress is clearly associated with down-regulation of a number of measures of cellular immune function with a shift in immunity from predominantly a Th1 to a Th2 type.  Furthermore, we know that there is a triangular relationship between mood (brain monoamines), the immune system and the HPA axis.  When one of the corners of this triangle becomes disregulated the others are inevitably affected. 1 The human aspect of cancer care can, therefore, not be overestimated.  Research has clearly indicated that support or lack of support, perceived caring and uncaring have great impact on the human being eg., by decreasing or increasing stress. If the virtue of caring is a human trait common to and inherent in all people, then uncaring can be some sort of burn-out.  Burn-out an occur over time and in stages.  It implies that individuals can undergo basic transformation during the development of burn-out and thus become qualitatively different.  I have proposed from my own research that the burnt-out health professional progress through the stages of disinterest, insensitively, coldness, inhumanity and maleficence.  From this point of view disinterest in cancer patients can be seen as a warning sign. Just as there can be a progression in burn-out with ever increasing uncaring, coldness and maleficence there can also be a progression in true compassion and genuine concern - this transformative and beneficent element in human encounters.  In the presence of a truly compassionate health professional, who is genuinely concerned for the patient, the patient feels safe and in good hands, stress is decreased and the patient feel empowered which increases his or her sense of well-being and health.  I sincerely hope that beneficence may increasingly be patients’ experience in their encounters with heath professionals and that we may progress towards the elimination of all shades of maleficence and dehumanization within health care.

 

Professor Sigridur Halldorsdottir, PhD (Md. Dr.)

Faculty of Health Sciences,

University of Akureyri,

Iceland.

1.   See e.g. Mind, Immunity and Health:  The Science of Psychoneuroimmunology by Professor Phil Evans, Dr. Frank Hucklebridge and Dr. Angela Clow – the senior members of the University of Westminster’s Psychophysiology and Stress Research Group.  Free Association Books: London, 2000.

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