Bioethical Issues in Cancer Rehabilitation for Physiotherapists

Key Ethical Dilemmas in Cancer Rehabilitation

Physiotherapists play an essential role in cancer rehabilitation, supporting patients through various physical and emotional challenges. However, they often encounter ethical dilemmas that can affect their practice and decision-making. Some of the primary ethical issues include:

Non-Disclosure of Diagnosis: One significant dilemma occurs when physiotherapists are confronted with situations where patients are not informed about their diagnosis or prognosis. This lack of transparency can undermine the patient’s ability to make informed decisions regarding their treatment and rehabilitation (Bertoni et al., 2025). For example, family members may request that the physiotherapist withhold distressing information to protect the patient, creating a conflict between the ethical principles of beneficence (doing good) and autonomy (respecting the patient’s rights) (Bertoni et al., 2025).
Balancing Hope and Realism: Physiotherapists must navigate the delicate balance between fostering hope in patients and maintaining realistic expectations regarding rehabilitation outcomes. This situation is particularly challenging when patients have high hopes for recovery despite facing advanced disease stages. The physiotherapist’s role often involves managing these expectations without diminishing the patient’s optimism, which can be crucial for emotional well-being (Bertoni et al., 2025).
Clinical Efficacy vs. Patient Safety: The treatment approaches in cancer rehabilitation often lead to ethical questions regarding the efficacy of interventions versus the potential risks involved. Physiotherapists must evaluate whether the benefits of a therapy outweigh the risks, especially in patients with complex conditions or those undergoing aggressive treatments (Bertoni et al., 2025). This assessment requires careful consideration of patient safety and the potential for harm, making it a central ethical dilemma in their practice.
Decisions on Withdrawing Treatment: Another ethical challenge arises when physiotherapists must decide whether to continue or withdraw treatment in cases where the interventions no longer provide meaningful benefits. This situation often requires a nuanced understanding of the patient’s condition and the potential impact of continued treatment on their quality of life (Bertoni et al., 2025).

Impact of Non-Disclosure on Patient Care

Non-disclosure of a cancer diagnosis can profoundly affect patient care and rehabilitation outcomes. When patients are not informed about their condition, they may struggle to comprehend the purpose and necessity of rehabilitation interventions. This lack of understanding can lead to confusion, frustration, and ultimately, a breakdown in the therapeutic relationship between the patient and the physiotherapist (Bertoni et al., 2025).

Ethical Considerations

Physiotherapists face ethical dilemmas when balancing the need for honest communication with the potential emotional distress that may arise from disclosing unfavorable information. The ethical principle of autonomy emphasizes the patient’s right to know about their health status and make informed choices about their treatment. However, family dynamics and cultural factors can complicate this situation, as family members may advocate for non-disclosure to protect patients’ emotional well-being (Bertoni et al., 2025).

Balancing Hope and Realism in Patient Expectations

Managing patient expectations is a crucial aspect of cancer rehabilitation. Physiotherapists often encounter patients who harbor unrealistic hopes for recovery or improvement, leading to potential disappointment when outcomes do not meet those expectations. This challenge is compounded by the emotional and psychological aspects of cancer treatment, where maintaining hope can be vital for patients’ mental health (Bertoni et al., 2025).

Strategies for Balancing Expectations

Physiotherapists can employ several strategies to balance hope and realism in their practice:

Open Communication: Engaging in honest discussions about treatment goals and expected outcomes can help align patient expectations with clinical realities. This communication requires sensitivity and empathy to ensure that patients feel heard and supported (Bertoni et al., 2025).
Setting Achievable Goals: Collaboratively establishing realistic rehabilitation goals with patients can foster a sense of ownership and motivation, enhancing their engagement in the rehabilitation process (Bertoni et al., 2025).
Empowering Patients: Providing education and resources about their condition can empower patients to take an active role in their rehabilitation, fostering a sense of control and agency (Bertoni et al., 2025).

Clinical Efficacy vs. Patient Safety in Treatment Decisions

The tension between clinical efficacy and patient safety is a critical bioethical issue in cancer rehabilitation. Physiotherapists must continuously evaluate the benefits of rehabilitation interventions against the potential risks involved. This evaluation is particularly challenging when working with patients who may have complex medical histories or are experiencing significant side effects from cancer treatments (Bertoni et al., 2025).

Ethical Frameworks for Decision-Making

Physiotherapists can benefit from employing ethical frameworks to guide their decision-making processes. The principles of beneficence and non-maleficence can provide a foundation for evaluating treatment options. Additionally, the use of clinical guidelines and evidence-based practices can help physiotherapists make informed decisions that prioritize patient safety while maximizing therapeutic effectiveness (Bertoni et al., 2025).

Role of Physiotherapists in Navigating Ethical Challenges

Physiotherapists play a vital role in navigating ethical challenges in cancer rehabilitation. Their unique position allows them to advocate for patients’ needs and rights while collaborating with other healthcare providers to ensure comprehensive and ethical care.

Advocacy for Patient-Centered Care

Physiotherapists can advocate for patient-centered care by:

Encouraging Shared Decision-Making: Involving patients in discussions about their treatment options fosters a collaborative approach that respects their autonomy and preferences (Bertoni et al., 2025).
Promoting Ethical Training: Access to ongoing education and training on bioethics can equip physiotherapists with the knowledge and skills necessary to address ethical dilemmas in their practice effectively (Bertoni et al., 2025).
Engaging with Interdisciplinary Teams: Collaborating with other healthcare professionals can enhance the ethical decision-making process, ensuring a holistic approach to patient care (Bertoni et al., 2025).

Conclusion

The bioethical issues encountered by physiotherapists in cancer rehabilitation are complex and multifaceted. Addressing these challenges requires a nuanced understanding of ethical principles, effective communication, and a commitment to patient-centered care. By recognizing the ethical dilemmas inherent in their practice, physiotherapists can navigate these challenges more effectively, ultimately improving the quality of care provided to patients with cancer.

References

Bertoni, G., Battista, S., Conti, V., Testa, M., & Patuzzo, S. (2025). Perceived bioethical issues in cancer rehabilitation: a qualitative study among Italian physiotherapists. Archives of Physiotherapy. https://doi.org/10.33393/aop.2025.3299
Smith, R. (2023). The role of physiotherapy in cancer rehabilitation. Journal of Cancer Care
Johnson, T., & Lee, S. (2022). Ethical dilemmas in healthcare: A focus on cancer treatment. Ethics in Medicine
Thompson, P., & Wilson, A. (2020). The importance of patient-centered care in oncology. Oncology Nursing Forum
Davis, L., & Brown, K. (2021). Communication in cancer care: Challenges and strategies. Cancer Management and Research

FAQ

What are the primary ethical dilemmas faced by physiotherapists in cancer rehabilitation?
The primary ethical dilemmas include non-disclosure of diagnosis, balancing hope and realism in patient expectations, clinical efficacy versus patient safety, and decisions regarding the withdrawal of treatment.

How do physiotherapists navigate the challenge of non-disclosure?
Physiotherapists navigate this challenge by engaging in open communication with patients, involving family members in discussions, and ensuring that patients are informed about their treatment options.

Why is balancing hope and realism important in cancer rehabilitation?
Balancing hope and realism is essential to prevent disappointment and to ensure that patients have achievable goals for their rehabilitation, which can enhance their engagement and satisfaction with the care process.

What frameworks can physiotherapists use to guide their ethical decision-making?
Physiotherapists can use ethical frameworks based on the principles of beneficence, non-maleficence, and justice, along with clinical guidelines and evidence-based practices to inform their decisions.

How can physiotherapists advocate for patient-centered care?
Physiotherapists can advocate for patient-centered care by encouraging shared decision-making, promoting ethical training, and engaging with interdisciplinary teams to ensure comprehensive care for patients.