Ethical Issues in Patients with Leukemia: Practice Points and Educational Topics for the Clinical Oncologist and Trainees

Leukemia represents a complex spectrum of malignancies, involving numerous treatment options and substantial symptom burden for patients. Ethical dilemmas may arise which challenge a physician's clinical management and the patient's goals of care. What is needed is the systematic analysis of the most common issues that confront clinical teams treating patients with leukemia in order to derive best ethical practices for optimized patient care. We examined 312 formal ethics consultations requested for patients with a leukemia diagnosis. We found that the most common ethical issues relate to the level of appropriate intervention, the futility of treatment and surrogate decisionmaking. The underlying causes stem from inadequately addressed psychosocial issues, disagreements between various stakeholders in the patient's care and miscommunication. Illuminating these issues provides areas of focus for the practitioner to refine their practice and inform educational initiatives. The integration of the clinical ethics service into the multidisciplinary team is a mechanism to foster a preventative ethics model and mitigate potential dilemmas.