Background: In the treatment of metastatic breast cancer and colorectal cancer one can broadly distinguish two options: palliative chemotherapy and palliatieve care. Palliative chemotherapy mainly focuses on survival benefits, and palliative care on the best quality of life. In practice most patients tend to choose for palliative chemotherapy, although the benefits can be marginal. In empirical ethics such dilemmas about values of quantity and of quality of life are disentangled. The Reflective Equilibrium method may be a useful instrument to do so.
Objectives: 1) To show in this conference in what way the Reflective Equilibrium (RE) method can be helpful to increase insight into ethical problems. We will focus on problems associated with (recent advances in) palliative chemotherapy, both in the context of individual patient care and in setting guidelines. 2) To demonstrate how the RE method can help in developing a normative framework to support decision making in palliative chemotherapy versus palliative care, for patients and physicians.
Methods: Ethical theories are related to qualitative empirical data in a continuous circular process that is called Reflective Equilibrium (RE). These ethical theories are derived from medical, philosophical, and medical ethical literature. The empirical data are gathered by qualitative methods, such as observations, in-depth and semi-structured interviews with patients and doctors, and an invitational conference. The RE, a methodological instrument of empirical ethics, enables one to detect implicit value judgements about a good life with advanced cancer, and enables one to develop an ethical theory that is sensitive to the facts of (moral) life. In the conference the RE method will be demonstrated on the basis of the results so far.