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

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 mat...

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Autores principales: Alpuim Costa, Diogo, Nobre, José Guilherme, de Almeida, Susana Baptista, Ferreira, Marisa Horta, Gonçalves, Inês, Braga, Sofia, Pais, Diogo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787159/
https://www.ncbi.nlm.nih.gov/pubmed/33425755
http://dx.doi.org/10.3389/fonc.2020.598508
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author Alpuim Costa, Diogo
Nobre, José Guilherme
de Almeida, Susana Baptista
Ferreira, Marisa Horta
Gonçalves, Inês
Braga, Sofia
Pais, Diogo
author_facet Alpuim Costa, Diogo
Nobre, José Guilherme
de Almeida, Susana Baptista
Ferreira, Marisa Horta
Gonçalves, Inês
Braga, Sofia
Pais, Diogo
author_sort Alpuim Costa, Diogo
collection PubMed
description 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.
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spelling pubmed-77871592021-01-07 Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis Alpuim Costa, Diogo Nobre, José Guilherme de Almeida, Susana Baptista Ferreira, Marisa Horta Gonçalves, Inês Braga, Sofia Pais, Diogo Front Oncol Oncology 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. Frontiers Media S.A. 2020-12-23 /pmc/articles/PMC7787159/ /pubmed/33425755 http://dx.doi.org/10.3389/fonc.2020.598508 Text en Copyright © 2020 Alpuim Costa, Nobre, de Almeida, Ferreira, Gonçalves, Braga and Pais http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Alpuim Costa, Diogo
Nobre, José Guilherme
de Almeida, Susana Baptista
Ferreira, Marisa Horta
Gonçalves, Inês
Braga, Sofia
Pais, Diogo
Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis
title Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis
title_full Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis
title_fullStr Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis
title_full_unstemmed Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis
title_short Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis
title_sort cancer during pregnancy: how to handle the bioethical dilemmas?—a scoping review with paradigmatic cases-based analysis
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787159/
https://www.ncbi.nlm.nih.gov/pubmed/33425755
http://dx.doi.org/10.3389/fonc.2020.598508
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