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The practices of medicine and law are both full of complex ethical and philosophical questions. Oncology further complicates the ethics landscape by introducing a plethora of nuanced variables—vulnerable patient populations, end-of-life decisions, experimental treatments, and high costs of care, to name a few. The question is not if but when oncology clinicians will encounter legal and ethical dilemmas. When such a dilemma arises, oncology clinicians and legal professionals can adopt a systematic approach based in applied medicolegal ethics.

It should be noted that this chapter is intended as a primer on medicolegal ethics and professionalism. A complete exploration of legal and ethical issues in oncology would merit volumes of discussion. Therefore, the scope of this chapter is limited to an accessible analytical framework for approaching these issues.

Before analysis of an ethical issue can occur, professionals must familiarize themselves with the foundational bases of medicolegal ethics. Once a foundation is established, a medicolegal ethics analysis can be applied to a variety of dilemmas, including conflicts of interest, oncologic research, and experimental treatments.


To create a solid starting point for a medicolegal ethics analysis, professionals in legal oncology should consider collectively (1) the organizing principles of biomedical ethics, (2) the fiduciary-beneficiary relationship, and (3) models of professional responsibility.

Biomedical ethics principles

Biomedical ethics analysis relies on a framework of four moral principles to guide professionals to a normative (i.e., based in common morality) conclusion. These principles are nonhierarchical—each principle is considered to be obligatory (prima facie) “unless it conflicts on a particular occasion with an equal or stronger obligation,” like another principle.1

The four principles of biomedical ethics are (1) respect for autonomy, (2) nonmaleficence, (3) beneficence, and (4) justice.

Respect for autonomy

The principle of respect for autonomy requires clinicians and other professionals to respect the rights of persons to make informed choices. Applied to oncology, this principle requires that respect must be given to the intentional choices made by patients. The principle further requires that patients be empowered to make intentional choices by being provided the information necessary to do so with understanding and that they are able to make such choices without undue external influences controlling their actions.

In oncology, as with virtually all forms of medical care, the question of paternalism will often arise. By definition, paternalism occurs when a clinician acts in what they believe is the best interest of the patient but against the patient’s autonomous choice or preference. Paternalism in medicine is to some extent unavoidable but should always be considered carefully. The principle of respect for autonomy also forms the bedrock of the doctrine of informed consent in health care. Regardless of whether a paternalistic action slightly or seriously diverges from a ...

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