Addressing the Ethical Challenges for Young Adults, from a Rights-Based Perspective

Abstract

Healthcare professionals frequently encounter ethical situations in their daily practice while caring for and making decisions with patients and other family members. They may often experience moral uncertainty and dilemmas about the best or right approach to handle ethical concerns. Ethical conflict can sometimes occur particularly when there is a clash of values between individuals, concerning which of the possible options should be chosen: such conflict can be potentially harmful and adversely affect the dynamics within the caring team. We sought to contribute to the narrative of real-world practice by drawing upon the experience of those delivering direct cancer care. We sought professional’s views to present a contemporary perspective on the ethical challenges they encounter while caring for young people with cancer. The narrative that follows has been constructed around the central themes that professionals encounter, which we wove into relevant literature and some personal reflections. The themes include stopping or not stopping when treatment is futile; delaying or avoiding difficult conversations, about cancer, around poor prognosis or end-of-life care; caught between competing obligations between family- and young adult-centred care; patient choice, when faced with treatment options and place of care, access to clinical trials/research and fertility options or when refusing treatment; and tensions between a professional’s personal moral compass, expectations attached to their role and conflict with team members. We argue here: 1.The need for models of care that are person-centred to promote positive and equitable engagement with patients, families and carers, empowering adolescents and young adults in making decisions and enabling them to actively influence their care.2.The need for an organisational culture that has established processes and practices that facilitate and support team discussions about ethical issues and dilemmas that occur in everyday clinical care.3.The need to create an effective ethical climate, where all perspectives are considered, shared decision-making is valued and open dialogue between team members is encouraged.