Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?-A Scoping Review With Paradigmatic Cases-Based Analysis

Diogo Alpuim Costa; José Guilherme Nobre; Susana Baptista de Almeida; Marisa Horta Ferreira; Inês Gonçalves; Sofia Braga; Diogo Pais

doi:10.3389/fonc.2020.598508

Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?-A Scoping Review With Paradigmatic Cases-Based Analysis

Front Oncol. 2020 Dec 23:10:598508. doi: 10.3389/fonc.2020.598508. eCollection 2020.

Authors

Diogo Alpuim Costa^{1

2}, José Guilherme Nobre³, Susana Baptista de Almeida⁴, Marisa Horta Ferreira⁵, Inês Gonçalves⁶, Sofia Braga^{1

2

4}, Diogo Pais⁷

Affiliations

¹ CUF Oncologia, Haematology and Oncology Department, Lisbon, Portugal.
² NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.
³ Universidade de Lisboa, Faculdade de Medicina, Lisbon, Portugal.
⁴ Hospital Professor Doutor Fernando Fonseca EPE, Oncology Department, Amadora, Portugal.
⁵ Universidade da Beira Interior, Faculdade de Ciências da Saúde, Covilhã, Portugal.
⁶ Hospital CUF Almada, Emergency Department, Almada, Portugal.
⁷ Ethics Department, NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.

Abstract

Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.

Keywords: cancer; carcinoma; ethical; ethics; gestation; neoplasm; pregnancy; pregnant.

Publication types

Review