Ethics in Mental Health and Oncology

May 2017

Ethics in Mental Health and Oncology

Depression is common in cancer patients, and the interactions between patients’ psychological and physiological experiences with cancer can pose significant ethical challenges for individual clinicians as well as health care systems. Oncological treatments can have a significant impact on patients’ mental health, while cancer patients with preexisting mental health conditions might require specialized care. The double stigma of cancer and mental illness introduces additional ethical complexities. How should physicians and other health care professionals maintain boundaries with cancer patients or integrate caregivers and surrogates into decision-making processes? What mental health screening processes should be implemented in cancer research and care settings? This month’s issue of the AMA Journal of Ethics explores these questions and underscores the need to provide empathic, well-integrated mental health care in oncology settings.

Volume 19, Number 5: 411-513 Full Issue PDF

From the Editor
May 2017

Unexplored Ethical Issues at the Intersection of Mental Health and Oncology
Weisheng Renee Mao
Introduction to the May 2017 issue on ethics in mental health and oncology.
AMA J Ethics. 2017; 19(5):413-415. doi: 10.1001/journalofethics.2017.19.5.fred1-1705.
Case and Commentary
May 2017

Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal
Joshua M. Baruth, MD, PhD and Maria I. Lapid, MD
Decision-making capacity can be preserved in patients with mental illness and should be formally assessed in the context of their values and past decisions.
AMA J Ethics. 2017; 19(5):416-425. doi: 10.1001/journalofethics.2017.19.5.ecas1-1705.
Case and Commentary
May 2017

Do Pediatric Patients Have a Right to Know?
Philip M. Rosoff, MD, MA
Some treatments of childhood cancer can cause infertility in adulthood. What should be the roles of physicians in helping parents decide whether, when, and what their child is told about this risk?
AMA J Ethics. 2017; 19(5):426-435. doi: 10.1001/journalofethics.2017.19.5.ecas2-1705.
Case and Commentary
May 2017

How Should Clinicians Respond to Transference Reactions with Cancer Patients?
Fatima Noorani, MD and Allen R. Dyer, MD, PhD
If a patient’s feelings become sources of resistance to treatment, clinicians need to know how to address these feelings’ influence on the therapeutic capacity of patient-clinician relationships.
AMA J Ethics. 2017; 19(5):436-443. doi: 10.1001/journalofethics.2017.19.5.ecas3-1705.
Case and Commentary
May 2017

Ethical Management of Patients with Cancer and Mental Illness
Laurel J. Lyckholm, MD and Arwa K. Aburizik, MD, MS
Decision-making capacity can be preserved in patients with mental illness and should be formally assessed in the context of their values and past decisions.
AMA J Ethics. 2017; 19(5):444-453. doi: 10.1001/journalofethics.2017.19.5.ecas4-1705.
In the Literature
May 2017

How Situational Diagnosis Helps Disentangle Ethical and Psychological Features of Complex Cases
Jerry Joseph Ignatius, DO and Walter Baile, MD
The method of situational diagnosis can be used to separate ethical issues from relational dynamics and legal constraints in complex cases.
AMA J Ethics. 2017; 19(5):454-459. doi: 10.1001/journalofethics.2017.19.5.nlit1-1705.
State of the Art and Science
May 2017

Assessing Psychological Toxicity and Patient-Reported Distress as the Sixth Vital Sign in Cancer Care and Clinical Trials
Thomas W. LeBlanc, MD, MA, MHS and Arif H. Kamal, MD, MBA, MHS
Clinical trials should assess patients’ distress and test interventions to address it, just as they assess adverse events and test novel therapeutic agents.
AMA J Ethics. 2017; 19(5):460-466. doi: 10.1001/journalofethics.2017.19.5.stas1-1705.
State of the Art and Science
May 2017

When and Why Should Mental Health Professionals Offer Traditional Psychodynamic Therapy to Cancer Patients?
David P. Yuppa, MD and Fremonta Meyer, MD
Psychodynamic therapy is generally suited to treating issues arising in cancer treatment because it enables rapid development of the therapeutic alliance.
AMA J Ethics. 2017; 19(5):467-474. doi: 10.1001/journalofethics.2017.19.5.stas2-1705.
Medicine and Society
May 2017

Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care
Kristen E. Riley, PhD, Michael R. Ulrich, JD, MPH, Heidi A. Hamann, PhD, and Jamie S. Ostroff, PhD
Clinicians can help mitigate stigmatizing messages from hard-hitting ads.
AMA J Ethics. 2017; 19(5):475-485. doi: 10.1001/journalofethics.2017.19.5.msoc1-1705.
Medicine and Society
May 2017

Prioritizing Mental Health Research in Cancer Patients and Survivors
Monica R. Martinez and Amirala Pasha, DO, MS
Research is needed to understand mental health effects of cancer at diagnosis, throughout treatment and the post-treatment phases, and in survivorship.
AMA J Ethics. 2017; 19(5):486-492. doi: 10.1001/journalofethics.2017.19.5.msoc2-1705.
Medicine and Society
May 2017

Should Clinicians Intervene If They Suspect That a Caregiver Whose Child Has Cancer Is at Risk of Psychological Harm?
Amy E. Caruso Brown, MD, MSc, MSCS
Physicians have an ethical responsibility to caregivers whose psychological distress is caused by their experience of the patient’s illness and treatment.
AMA J Ethics. 2017; 19(5):493-500. doi: 10.1001/journalofethics.2017.19.5.msoc3-1705.
Art of Medicine
May 2017

From Silence into Language: Questioning the Power of Physician Illness Narratives
Amy E. Caruso Brown, MD, MSc, MSCS and Rebecca Garden, PhD
Physician illness narratives create a bond with patients through the shared experience of vulnerability but risk extending the physician’s own authority.
AMA J Ethics. 2017; 19(5):501-507. doi: 10.1001/journalofethics.2017.19.5.imhl1-1705.
Art of Medicine
May 2017

They Are People First, Then Patients
Mónica Lalanda, MD, MSc, Eva Gracia-Peligero, MD, and Maria Teresa Delgado-Marroquín, MD, PhD

AMA J Ethics. 2017; 19(5):508-509. doi: 10.1001/journalofethics.2017.19.5.imhl2-1705.
Podcast
May 2017

Ethics Talk: The Importance of Spiritual Care Referrals for Cancer Patients - An Interview with Dr. Tarris Rosell

AMA Journal of Ethics theme editor Renee Mao, a third-year medical student at the George Washington University School of Medicine and Health Sciences, interviewed Dr. Tarris Rosell, PhD, DMin, MDiv, about strategies for incorporating spiritual care into oncology.

Ethics in Mental Health and Oncology

Unexplored Ethical Issues at the Intersection of Mental Health and Oncology

Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal

Do Pediatric Patients Have a Right to Know?

How Should Clinicians Respond to Transference Reactions with Cancer Patients?

Ethical Management of Patients with Cancer and Mental Illness

How Situational Diagnosis Helps Disentangle Ethical and Psychological Features of Complex Cases

Assessing Psychological Toxicity and Patient-Reported Distress as the Sixth Vital Sign in Cancer Care and Clinical Trials

When and Why Should Mental Health Professionals Offer Traditional Psychodynamic Therapy to Cancer Patients?

Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care

Prioritizing Mental Health Research in Cancer Patients and Survivors

Should Clinicians Intervene If They Suspect That a Caregiver Whose Child Has Cancer Is at Risk of Psychological Harm?

From Silence into Language: Questioning the Power of Physician Illness Narratives

They Are People First, Then Patients

Ethics Talk: The Importance of Spiritual Care Referrals for Cancer Patients - An Interview with Dr. Tarris Rosell

Other Issues

Legitimacy and Authority in Medicine

Language and Hierarchy in Medicine

Moral Psychology and “Difficult” Clinician-Patient Relationships