r/bioethics

What are the medicoethical considerations surrounding a physician from providing an adjunctive but non-curative therapy for cancer?

I will be heading up a hyperbaric oxygen therapy program and have heard of a potential new patient with cancer who is eager to have HBO sessions.
I don’t know the details of this patient’s particular situation yet but, in general, how would you think about this situation ethically?

Here are my *a prioris* :

1. HBO does NOT cure or really treat cancer.

2. HBO is generally safe for cancer patients (little to no evidence of cancer progression. Some very specific exceptions but those even are mild at worst)

3. HBO can provide some relief of side effects from radiation and can be helpful as a adjunctive supplement to chemotherapy. Almost like supercharger for some medications.

4. Providing false hope, or allowing the patient to have false hope of more benefits is morally wrong.

Guiding principles that seem to be involved: beneficence, primo non nocere, justice, pt autonomy

Step 1: Have a thorough discussion with the patient regarding their condition, goals of therapy, beliefs of outcomes, etc.

Step 2: Be explicitly clear about the limitations of the therapy. Very clearly disabusing them of any belief that this is primary treatment option and will “cure” cancer

Step 3: Proceed with treatment with frequent reevaluation and stop if harm or lack of effect.

Questions:

1. Would you insist that the patient be undergoing “conventional” treatment simultaneously and/or coordinate with their oncologist?

2. What if they want HBO and WON’T be dissuaded from the incorrect idea that HBO is somehow curative? What are the physicians ethical obligations to provide therapy towards a treatment plan they don’t agree with?

3. What am I missing or not asking?

Sorry if this isn't allowed but this is sort of a repost. This also is very relivant to this subreddit aswell as the that I posted it to eariler.

For context IB is a higschool college credit program. Similar to AP in the US and EE or extended essay is required to graduate

I am working on my EE for FA 27, and I have put some deep thought into the ethics of my research.

Main Problem:
I want to do biology EE, and I want to do it on coral. This comes with extra restrictions; I understand why they are there and are needed, but I also think that the IB is possibly too restrictive. And this is my proposed experiment:

Experiment:

Coral bleaches, for the most part, I think we understand that this is related to stress and don't have to go down the rabbit hole of the metabolic processes of that, if you want, I'd love to nerd out about it with you, though. But I digress, in recent times, there has been a lot of research into how thermal stress affects the coral, while also acknowledging that there are other stress factors like UV, but not diving into them as deeply due to the priority that thermal stress takes over the others *cough cough SUPER EL NINO cough cough.

I want to look into the UV stress and if it unlocks different pathways in the coral through genomics. I have both the knowledge from me and my mentors at grad school labs around me to be able to do this, so I think if I really wanted to, this data could be valid enough to be publishable.

But in order to do this, I need to "stress" the coral enough for it to begin its bleaching process. Through literature examination, it only has to be for a couple of days, and coral is able to recover after this time period. But it does violate the rule of IB which doesn't want me to cause unnatural stress in an animal.

Coral is in the kingdom of animals. But I feel that the goal of IB's rules is to prevent the suffering of animals that can feel the suffering. I understand why we can't experiment on vertebrates, rats, and cause stress aswell as experiment on invertebrates and crustaceans like snails or crabs. But I feel that in the sprit of these rules is to prevent suffering but coral can't feel suffering like a crab can. IB allows us to experiment on plants, who respond to stress more similarly to a coral Cnidaria than it does to something like a tape worm. If the IB cared about an organism's ability to react to stress then it would not let us experiment on anything living as "responding to stimuli" is one of the core pillars of what defines life, but it lets us experiment on bacteria and plants to the point of killing it or letting it "suffer".

Concluding thoughts:

First of all, thank you for reading this far. I am aware that this is somewhat of a hot take, but I feel that the rules of IB in this very specific case could afford to be more specific, and specificity would rarely do any harm compared to leaving it as vague as it is.

Additionally, I have a permit for coral collection so even though its protected I can still take it, with limits of course. I also have the rare opportunity to spawn coral and experiment on lab grown coral so it may not even be "wild coral".

The environmental impact is minimal to not even at all. No rule other than IB's is limiting this research nor does IB's rules prevent suffering because I am using stocks that have already grown and collected.

Again, I understand why these rules are in place and overall I think they are good. But in this case i'd like to seek clarity and advice from people wiser than I rather than gambiling my IB dipolma and leaving it in the hands of a single examiner reading my EE.