Disentangling ethical and psychological issues - A guide for oncologists

The rapid growth of bioethics has injected a new style of analysis into med icine. It requires philosophical rigor, yet is deeply embedded in human sit uations that frustrate abstract thinking and are laced with subjective fact ors. These interlaced ethical and psychological components can lead to conf licts and dilemmas. Doctors, as experts and decision-makers, play a key rol e, but will benefit from additional skills to disentangle these situations. This paper notes ways in which patients, families and caregivers are newly vulnerable and delineates how ethical dilemmas and psychological issues mo ld or frustrate decision-making. To help physicians manage such cases, a me thod of systematic analysis, the 'situational diagnosis', and a related hie rarchy of interventions, is described and illustrated with case examples.