A very interesting article was recently published in the Journal of Oncology Practice entitled, "Addressing Fertility in Patients With Advanced Cancer: How the Quality Oncology Practice Initiative Standards and ASCO Guidelines Facilitate Ethical Communication.1 " The full article can be downloaded here.
The article tackles the issue of the oncologist's responsibility in discussing fertility preservation treatments with patients whose cancer the believe is incurable. Understandably the issue raises many possible moral issues for the oncologist. The authors state that oncologists may feel that discussing future fertility could send mixed messages to the patient about the severity of their prognosis, or that fertility preservation techniques could delay necessary cancer treatment; a concern that mostly applies to the female patient. Additionally, the oncologist might worry about the adverse effects on any child produced who seems destined to lose a parent to cancer.
While these are obvious reasons that an oncologist might feel uncomfortable addressing these questions with a patient who has advanced cancer, the authors of the paper conclude that good medical practice, and guidelines from the American Society of Clinical Oncology, both dictate that the issue should at least be broached. While not requiring an exhaustive review of all fertility preservation methods or recommendation of a preferred preservation regimen, the authors do point out that if the oncologist does not mention the issue, then they are essentially making the decision of non-action for the patient. In an opinion regarding the sharing of fertility preservation information that is shared by the Oncofertility Consortium, the authors write provocatively that, "...decisions about reproduction are extraordinarily personal and need to be left up to the patients and their families. The role of the oncologist is not to serve as a gatekeeper for information for the patient just because the patient might make a decision the oncologist believes would be inappropriate."
1. Debon DJ, Kohnke JM, and Helft PR (2009). "Addressing Fertility in Patients With Advanced Cancer: How the Quality Oncology Practice Initiative Standards and ASCO Guidelines Facilitate Ethical Communication." Journal of Clinical Oncology 5(6): 298-300.