Ethics and cancer: a survey of the literature

We have identified 776 articles, books, book chapters, and letters published since 1945 dealing with both ethics and cancer. Of this number, 473 (61%) were discussions in medical and scientific journal articles; they were published in 188 journals, demonstrating the scattered nature of this literature. The recent increase of writing in ethics and cancer has been dramatic, the median year of publication being 1979. Although the majority of articles addressed more than one ethical issue, the most common topic was whether patients should be told the truth about their diagnosis and prognosis (found in 241 of the items identified). The ethics of cancer research has only recently assumed importance in the medical literature, the median year of publication being 1981. The great interest in the ethics of cancer research is evident in that 255 (33%) of the 776 items dealt with research, 104 of these focusing on randomized trials. Besides truth-telling and research, 78 other issues are being discussed, among them informed consent for adults (119 items), the physician's responsibility for psychologic management of patients (79 items) and their families (68 items), responsibilities of nurses (58 items), the use and testing of laetrile (55 items), and euthanasia (38 items). Surgery was discussed in 90 items, pediatrics in 71, and radiotherapy in 44. The authors of this literature relied upon at least nine identifiable ethical positions. Only a limited number of authors were aware of the philosophic literature and of the complexities inherent in defining such terms as "benefit," "harm," and "quality of life."