Ethical issues in palliative care research

During the last 10 years interest in palliative care research has grown. This interest has brought about an awareness of the unique ethical issues related to research in this special population. Issues related to the vulnerability of patients and families, consent protocols, unstable mental status, and the invasiveness of assessments have been discussed. Unfortunately, devastating physical and psychosocial distress continue to afflict the majority of cancer patients before death. Although our current knowledge of palliative care allows us to help a significant number of patients and families, there are a number of symptoms that are currently intractable. Further, a 50% increase in the number of cancer deaths in Canada is expected between 1990 and the year 2000 (11). Therefore, one of the major ethical issues we must confront during the coming decade is whether we can afford not to make a major commitment to research in palliative care. We are aware that maintaining the status quo of patient care is unacceptable. However, until now, administrators, governments, and clinicians have planned palliative care programs to have only service and some teaching components. And traditional research-sponsoring agencies have not allocated priority to palliative care in their funding strategies. The palliative care community must take the initiative in this debate.