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Ethical issues related to the COVID-19 pandemic in patients with cancer: experience and organisations in a French comprehensive cancer centre
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  1. François Blot,
  2. Sarah N Dumont,
  3. Laurence Vigouret-Viant,
  4. Nelly Verotte,
  5. Julien Rossignol,
  6. André Rieutord,
  7. Nathalie Fournier-Bidoz,
  8. Anne De Jésus,
  9. Sarah Dauchy,
  10. Florent Chardonnet,
  11. Capucine Baldini and
  12. Anna Altea
  1. Ethics Committee, Gustave Roussy Institute, Villejuif, France
  1. Correspondence to Dr François Blot, Ethics committee. Intensive Care Unit, Gustave Roussy Institute–Université Paris Saclay, 94800 Villejuif, Île-de-France, France; francois.blot{at}gustaveroussy.fr

Abstract

Background The COVID-19 pandemic has aggressively reached the most vulnerable, not only the elderly but also patients with chronic conditions such as cancer. In this study, we present the outlines of ethical thinking and the measures implemented to try to respect our basic values of care, in the specific environment of an oncology hospital.

Methods Our ethics committee created an ethical watch system based on 24/7 shifts to assist practitioners in their daily decisions. We discuss the challenges faced by patients with cancer during the pandemic, such as access to critical care and ethical dilemmas in the context of resource scarcity, as well as the issue of isolation of patients. We also debate the restrictions in access to oncology care in a health context strongly ‘prioritised’ against COVID-19.

Results In all areas of an ethical dilemma, either for sorting out access to critical care or for the dramatic consequences of prolonged isolation of patients, our common thread was our attempt to protect, whenever possible, the principles of deontological ethics by strictly resisting utilitarian pressure. Respecting democratic health decision-making processes is a cornerstone of ethically relevant decisions, including in the context of a sanitary crisis.

Conclusion The role of an ethics committee related to real-life situations includes not only a reflexive perspective in respect of fundamental principles, but also the help to enlighten and resolve ethical dilemmas in complex clinical situations. This ethical watch team assists physicians in decision-making, promoting the supportive and palliative dimension of care with a holistic approach.

  • supportive care
  • ethics
  • cultural issues
  • clinical decisions

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Footnotes

  • Contributors FB, SND, LV-V, NV, JR, AR, NF-B, ADJ, SD, FC, CB and AA contributed equally to the planning, conduct and reporting of the work described in the article. FB, head of the ethics committee, is the main author and first wrote the article, with the help of SND. FB is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval An ethics committee approval was not required for this paper.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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