Ethics of palliative surgery in esophageal cancer

Surgery is one of the important palliative methods for patients withesophageal cancer. In addition to concerns related to clinical decision making, various moral challenges are encountered in palliative surgery. Some of them are related to patients and their illness, others to surgeons, their attitudes, skills and knowledge base.

Pertinent moral challenges are addressed and analyzed with respect to prevailing perspectives in normative ethics (Ross style pluralism). Demandsregarding sensibility and precaution in this clinical setting represent substantial challenges with regard to the beneficence, non-maleficence, justice, autonomy and proper patient information.

Moreover, variations in definition of palliative surgery as well as limited scientific evidence in efficacy, effectiveness and efficiency pose methodological and moral problems. We have shown that ethical principles (beneficence, non-maleficence, and justice) in all procedures and treatments in esophageal cancer, including psychological problems of the patients are effective in improving their quality of life.

Both surgical skills and moral sensibility are required to improve surgical palliative care in esophageal cancer, and should be taken into account not only in clinical practice but also in education and research.