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Ethical Decision Making About End-of-life Care Issues by Pediatric Oncologists in Economically Diverse Settings

Sanchez Varela, Ana M. MD, MPH; Johnson, Liza-Marie MD, MPH, MSB; Kane, Javier R. MD; Kasow, Kimberly A. MD; Quintana, Yuri PhD; Coan, April MPH; Yuan, Ying PhD; Barfield, Raymond MD, PhD; Church, Christopher PhD; Hester, Micah PhD; Baker, Justin N. MD

Journal of Pediatric Hematology/Oncology: May 2015 - Volume 37 - Issue 4 - p 257–263
doi: 10.1097/MPH.0000000000000271
Original Articles

Purpose: Pediatric cancer represents 1% to 4% of all cancers worldwide, with the majority of diagnoses in developing countries where mortality remains much higher than that in high-income countries. We sought to describe differences in ethical decision-making at the end of life among an international sample of pediatric oncologists practicing in countries with a variety of income levels and resource settings.

Methods: Pediatric oncologists subscribing to an educational international oncology Web site were invited to complete a 38-item web-based survey investigating ethical domains related to end-of-life care: level of care, fiduciary responsibility, decision making, and justice.

Results: Responses were received from 401 physicians in 83 countries, with most respondents practicing in middle-income or high-income countries. Significant differences in attitudes toward ethical issues existed across the national developmental indices.

Conclusions: Further education on ethical principles is warranted in pediatric oncology, particularly among oncologists practicing in low-income or middle-income countries.

*University of North Carolina at Chapel Hill, Chapel Hill

§Duke University, Durham, NC

Texas A&M Health Science Center, Temple, TX

St Jude Children’s Research Hospital, Memphis, TN

Arkansas Children’s Hospital, Little Rock, AR

A.M.S.V. and L.-M.J. are co-first authors.

Supported in part by NIH Cancer Center Support Core Grant CA-21765 and the American Lebanese Syrian Associated Charities (ALSAC).

The authors declare no conflict of interest.

Reprints: Justin N. Baker, MD, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 260, Memphis, TN 38105 (e-mail:

Received July 18, 2014

Accepted September 11, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.