Ethical issues and the breast cancer patient.

The association of cancer and death in laypeoples' thinking has resulted in discussions of cancer diagnoses often being held sub rosa. Open acceptance of a diagnosis of cancer cannot only help to dispel associated fears but also can serve to educate other persons to recognize that cancers can be cured. Open discussion of diagnoses of breast cancer by well-known public figures increasingly has focused media attention on related issues. Numerous ethical issues applicable to breast cancer (and to other chronic and/or cancer diagnoses) include: informed consent; education of relatives, friends, and public; patients' comfort in discussion of their diagnoses and treatment; access to care; and allocation of scarce resources. Genuine informed consent involves discussions of all relevant medical issues with the patient so that she understands the ramifications of the diagnoses, treatment, risks, and benefits of undergoing or of refusing treatment; and enables the patient to make a reasoned autonomous decision. Sufficient time must be allowed for development of this understanding because all persons, but especially apprehensive patients, tend to be selective in their hearing of explanations: to hear what they are afraid to hear, what they want to hear, and what they are prepared to hear. Limitations of funding for health care raise further questions about access to needed treatment. The concerns of the NIH Office of Research on Women's Health and of the Women's Health Initiative include breast cancer, as do those of the populace at large.