Table 3

Ethical dilemmas encountered and selected guidelines during onco-palliative ethics meetings for patients with advanced cancer and COVID-19

Ethical dilemmasSelected guidance
Resuscitation status
  • Risk of limiting treatments too readily

  • Risk of deciding on active resuscitation without exploring the patient’s wishes

  • Systematic assessment of information needs and collection of patient’s and relatives’ opinions,

  • Discussion at patient admission.

    Reassessment according to new medical events.

  • Resuscitation order if life expectancy longer than 1 year and patient’s and relatives’ agreement.

  • Clear statement to resist utilitarian choices.

Benefit–risk balance of cancer treatment
  • Risk of tumour progression in case of delayed anticancer treatment

  • Risk of neutropaenia and pulmonary infection in case of chemotherapy

  • Systematic assessment of information needs and collection of patient’s and relatives’ opinions.

  • Postponement of cancer treatment until COVID-19 disease cure.

  • Exception possible if pleuropulmonary tumour, or other life-threatening tumour, with required conditions

    • Preserved autonomy.

    • Available treatment with no haematological or pulmonary toxicity.

Terminal acute respiratory failure management
  • Risk of asphyxia

  • Risk of relatives’ distress if not allowed to visit dying loved ones

  • Systematic assessment of information needs and collection of patient’s and relatives’ opinions.

  • Application of French law allowing

    ‘deep, continuous sedation until death’.

  • Visiting authorisations with strict respect for local safety measures.