In complex and challenging cases, care should be individualised to reflect a patient’s unique situation, values and goals
In all areas of medicine, we encounter complex and tragic cases that challenge our medical expertise, our emotional resources, our clinical judgement and our capacity to make ethical decisions. In challenging cases where there is a diagnosis of a progressive life-limiting illness, a palliative care team may have much to offer. The patient we describe here, a young pregnant woman diagnosed with incurable malignancy, represents one such case. Only by working with the patient at the centre, surrounded by collaborating specialist staff, can we negotiate the path to the “right” care.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Baergen RN, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121: 508-511.
- 2. Alexander A, Samlowski WE, Grossman D, et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21: 2179-2186.
- 3. Altman JF, Lowe L, Redman B, et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol 2003; 49: 1150-1154.
- 4. Chervenak FA, McCullough LB, Knapp RC, et al. A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy. Cancer 2004; 100: 215-222.
- 5. Patni S, Wagstaff J, Tofazzal N, et al. Metastatic unknown primary tumour presenting in pregnancy: a rarity posing an ethical dilemma. J Med Ethics 2007; 33: 442-443.
- 6. Milliez J, Cayol V. Palliative care with pregnant women. Best Pract Res Clin Obstet Gynaecol 2001; 15: 323-331.
- 7. Tuohey JF. Terminal care and the pregnant woman: ethical reflections on In Re: A.C. Pediatrics 1991; 88: 1268-1273.
We would like to thank the patient’s husband for giving us permission to write her story. We would also like to acknowledge the importance of all the health care professionals who looked after this young patient. Her journey and uniqueness, including her approach to her uncertain and difficult future, clearly touched those who cared for her.
None identified.