Ethical Challenges in Providing Psychological Care to a Pregnant Adolescent With Cancer

Abstract

Objective: There are numerous psychosocial and ethical complexities in the medical and psychological care of an adolescent with cancer and a concurrent pregnancy. The article aims to discuss specific ethical dilemmas in a case, proposed frameworks for managing these complexities, and a summary of how the psychologist navigated these difficulties. It is notable that many states in the United States allow minors to legally consent for care related to their pregnancy but not their own psychological or oncological care. Methods: This article discusses a unique and complex case encountered by a pediatric psychologist specializing in psycho-oncology, including a discussion of the numerous challenges faced. Relevant cultural considerations are also discussed. Results: The case is further complicated when the patient experiences a spontaneous abortion and disagreements arise between the parents and the psychologist about how to acknowledge the loss. In addition, there is a lack of legal and ethical clarity related to an adolescent’s ability to consent to therapy addressing a pregnancy-related loss. Specific ethical issues that arose in this case pertain to beneficence, nonmaleficence, and respect for rights and dignity for both the patient and for her parents. Considerations for resolving ethical dilemmas are presented, including the use of an ethical framework. Conclusions: There is limited research and discussion in the literature about how to manage psychological goals of care disagreements. It would be beneficial to have additional research, case reports, and clearer laws and ethical guidelines related to the parameters of adolescent pregnancy consent.

Implications for Impact Statement

This article discusses complex legal and ethical ambiguities that arise when providing psychological care to a pregnant teenager receiving cancer treatment. The case demonstrates the importance of a pediatric psychologist being able to evaluate and attempt to resolve complex ethical dilemmas, particularly in the context of a family’s culture and values.

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