Children with cancer in India: An ethical framework for practice

Childhood cancer has been ranked the most common cause of death due to non-communicable disease among 5- to 14-year-old children in India. Ethical concerns have been identified in the care of children with cancer in India, yet there is a paucity of ethical standards for clinical practice to help address these concerns. For example, emerging research has demonstrated that many children are distressed when they are impeded from participating in discussions and decisions regarding their cancer care. Therefore, we sought to create an ethical framework to guide practice with this population.

We developed this ethical framework by conducting (a) a normative analysis of relevant documents that articulate norms for healthcare providers working with children in India and (b) stakeholder consultations with childhood cancer survivors, parents, and clinicians.

The ethical framework is structured according to twelve key ethical principles and corresponding challenges or implications for clinical practice. We discuss how this ethical framework can help address three leading ethical concerns that we have identified within the care of children with cancer in India: (a) communication problems; (b) inadequate care of symptoms or promotion of comfort; and (c) injustices or inequities related to limited financial means or poverty.

Ethical concerns that have been related to the care of children with cancer in India can be prevented or at least mitigated through the integration of this ethical framework in everyday clinical practice.