Law and Ethics
Reflections on Cancer’s Toll on My Family
Govind Persad, JD, PhD
Over the past 2 years, my family and I have experienced firsthand the challenges of cancer. In the spring of 2021, my mother was diagnosed with stage IIB pancreatic cancer. She died in mid-2023 after developing metastatic disease, including peritoneal carcinomatosis. The experience has caused me to ...
Distributing Scarce Cancer Drugs Legally and Ethically
Govind Persad, JD, PhD
During the COVID-19 pandemic, many medical specialties became familiar with supply chain interruptions resulting in drug, equipment, and personnel scarcity. Intensive care unit beds, staff, and essential medicines were at times in short supply. The federal government, individual states, and locali...
Addressing Health Disparities in Oncology Care—Legally and Ethically
GOVIND PERSAD, JD, PhD
A health disparity is typically defined as involving a differential in health outcomes between some groups of patients and other groups, for example, between White and Black patients, in which some groups fare better than others. Health inequities are commonly defined as health differences that ar...
Understanding the Health Provisions in the Inflation Reduction Act and Their Implications for Oncology Care
Govind Persad, JD, PhD
The Inflation Reduction Act of 2022, signed into law on August 16, 2022, contains several important provisions regarding health care and drug pricing.1 In this article, I provide an overview of the legislation’s implications for oncology care, focusing on its provisions concerning drug price negotia...
Legal and Ethical Use of Complementary and Alternative Medicine Interventions in Oncology
Govind Persad, JD, PhD
In addition to, or instead of, receiving therapies that are the standard of care, patients with cancer sometimes request to receive complementary (therapies used in conjunction with standard cancer treatment) and alternative (nonstandard treatments used in place of standard cancer treatment) medical...
How the Biden Administration Is Changing Oncology Care
GOVIND PERSAD, JD, PhD
A change in presidential administrations has implications across the health sector, including for oncology. In this column, we review some recent actions by Congress and the Biden administration and their implications for the oncology community. We focus on three areas: funding for patients and pr...
Challenges Related to Informed Consent and Information-Sharing for Minors With Cancer
Govind Persad, JD, PhD
Here we discuss a complex and often emotionally wrenching challenge related to informed consent in the provision of pediatric cancer care. For example, what legal and ethical claims do young patients have to information about their cancer diagnosis and treatment recommendations? What are the obstacl...
How Telemedicine Is Impacting Oncology Care During the COVID-19 Pandemic
Govind Persad, JD, PhD
The expansion of telemedicine has been one of the most important developments during the COVID-19 pandemic. Here, we discuss some of the legal and ethical dimensions of expanding telemedicine services in oncology practices. As Royce et al discussed in a recent JAMA Oncology article, Congress expand...
Firing Your Patient: How to Terminate a Treatment Relationship
Thaddeus Mason Pope, JD, PhD
Many clinicians are confused by the evolving opioid prescribing guideline issued by the Centers for Disease Control and Prevention (CDC) meant to stem the rising epidemic of opioid addiction and overdose in the United States.1 Many are also worried about regulatory oversight by the U.S. Drug Enfor...
Should You Become an Expert Witness in a Legal Proceeding? Here Are the Pros and Cons
Thaddeus Mason Pope, JD, PhD
Hundreds of oncologists are working “side gigs” as expert witnesses in a wide range of medicolegal settings. With increasing conflict related to liability and insurance coverage, the demand continues to grow for objective physicians who are not involved in a specific case, have no personal interes...
Parental Treatment Refusals: What Your Responsibilities Are When Mom and Dad Decline Cancer Treatment for a Child
Thaddeus Mason Pope, JD, PhD
In April 2019, a 3-year-old boy, Noah McAdams, missed the third round of chemotherapy for his acute lymphoblastic leukemia. His parents wanted instead to focus on alternative remedies of cannabidiol oil, alkaline water, mushroom tea, and herbal extracts. The sheriff was summoned; Noah’s parents lost...
Curbside Consults: New Liability Risks to Avoid When You Are Not a Patient’s Physician
Thaddeus Mason Pope, JD, PhD
Like most clinicians, oncologists often informally consult their colleagues, both asking questions and seeking suggestions on how best to care for their patients.1,2 These informal or “curbside” consults (sometimes called “sidewalk,” “elevator,” or “hallway” consults) are valuable, because the fre...
Full Disclosure: What Oncologists Must Tell Patients About Their Experience and Training
Thaddeus Mason Pope, JD, PhD
Informed consent is an important part of delivering quality cancer care. Traditional ethical and legal rules require clinicians to disclose three types of information: (1) the patient’s diagnosis; (2) the nature of the proposed intervention and its intended benefits, risks, and adverse effects; an...
Ensuring Advance Directives Are Followed and Lawsuits Are Avoided
Thaddeus Mason Pope, JD, PhD, has focused his legal career on improving medical care decision-making and protecting patients’ rights at the end of life. His specific areas of legal expertise include patients’ rights, informed consent, and end-of-life medicine. Dr. Pope is the coauthor of The Right...
Informed Consent and the Oncologist: Legal Duties to Discuss Costs of Treatment
Thaddeus Mason Pope, JD, PhD
For 50 years, clinicians in the United States have had a legal duty to disclose to patients with cancer the risks, benefits, and alternatives to a proposed cancer treatment. Until recently, however, it has been unclear whether clinicians have a similar duty to discuss the costs of that t...
Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles
Thaddeus Mason Pope, JD, PhD
In 2017, the District of Columbia (DC) became the seventh jurisdiction in the United States to legalize medical aid in dying,1 which gives terminally ill patients the option of how and when they die. The new DC statute is nearly identical to earlier enacted medical aid in dying statutes in Califor...
Providing Cancer Treatment Without Patient Consent
Thaddeus Mason Pope, JD, PhD
Law and Ethics in Oncology explores the legal and ethical issues oncologists must be aware of in this era of precision medicine and changing health-care policy, both to protect patients’ rights and to safeguard against potential legal jeopardy. Increasingly, across the United States, hospitals are ...
Legal Duties of Clinicians When Terminally Ill Patients With Cancer or Their Surrogates Insist on ‘Futile’ Treatment
Thaddeus Mason Pope, JD, PhD
Law and Ethics in Oncology explores the legal and ethical issues oncologists must be aware of in this era of precision medicine and changing health-care policy, both to protect patients’ rights and to safeguard against potential legal jeopardy. For years, ASCO and other medical societies have lamen...
How to Respond to a Patient’s Discriminatory Request for a Different Clinician
Thaddeus Mason Pope, JD, PhD
Some patients may make discriminatory requests for a different clinician for their health care.1-5 These individuals may want to avoid treatment with clinicians of a certain race, religion, gender, sexual orientation, or national origin. Oncologists are not exempt from this type of patient behavio...
Decision Aids Reflect Patients’ Values and Preferences for Care: So Why Aren’t More Oncologists Using Them?
Thaddeus Mason Pope, JD, PhD
Overwhelming evidence shows that patient decision aids, such as educational booklets, videos, or Web-based tools that take into account patients’ values and personal preferences, hold enormous promise for improving the informed consent process. Patient decision aids both reduce unwanted medical ...
Voluntarily Stopping Eating and Drinking Is Legal—and Ethical—for Terminally Ill Patients Looking to Hasten Death
Thaddeus Mason Pope, JD, PhD
Terminally ill patients with cancer will sometimes ask their clinicians for help with assisted or hastened death.1 Although palliative care and hospice care can usually address the concerns of most patients, some have physical or existential suffering that is refractory to comfort and supportive c...
Expanding the Use of Provider Orders for Life-Sustaining Treatment for Patients With Advanced Cancer
Thaddeus Mason Pope, JD, PhD
Patients with advanced cancer often get more aggressive treatment than they want because too few oncologists elicit their end-of-life treatment preferences.1,2 In response to this problem, leading associations, including ASCO3,4 and the Institute of Medicine,5 have called for more advance care pla...
New Laws Limiting Opioid Prescriptions Create Undue Barriers for Patients With Cancer and Cancer Survivors
Thaddeus Mason Pope, JD, PhD
Among other policy responses to the growing opioid epidemic, many states have enacted legislation that limits the duration or amount of opioid prescriptions issued by physicians. Although, it is clear we need strong measures to mitigate widespread overuse and misuse of opioids. These prescription-...
New Regulations Require Better Communication With Patients Who Have Disabilities and Limited English Proficiency
Thaddeus Mason Pope, JD, PhD
Ever since President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010, the nondiscrimination provision of the law, Section 1557, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health...
Health-Care Fraud Prosecutions Are on the Rise
Thaddeus Mason Pope, JD, PhD
Prosecuting health-care fraud is a top priority for the U.S. Department of Justice (DOJ) and other federal government agencies.1,2 After all, the government earns a $6 return for every $1 that it spends on enforcement. In December 2018, the DOJ announced that it had obtained more than $2.5 billion i...
