In 2020, there were ~1.4 million new cases and 375 000 deaths globally. The projected figures for 2040 suggest an increase to around 2.3 million cases and at least 740 000 deaths, driven by population growth and ageing.

The disparity in incidence and mortality rates between developed and developing regions, such as Southern Africa, highlights ethical concerns related to resource allocation, screening, and treatment.

The high incidence of PCa in developed countries, partly due to widespread PSA screening, contrasts with lower mortality rates compared to regions like Southern Africa, where socioeconomic, sociocultural, and genetic factors contribute to higher death rates. In Southern Africa, PCa accounts for 13% of cancer-related deaths among men, reflecting significant disparities in healthcare access and quality.

The ethical dilemmas in PCa care stem from balancing patient needs with available resources. Medical ethics, which has evolved since the 1970s but has roots in earlier philosophical traditions, guides these decisions. The principles of medical ethics include:

1. Respect for autonomy: This principle underscores the importance of honoring a patient's right to make informed decisions about their care. Informed consent is a key aspect, ensuring that patients understand their options and the potential outcomes of their choices.
2. Beneficence: Healthcare professionals are obligated to act in the best interest of patients, aiming to provide treatments that benefit their health and well-being.
3. Non-maleficence: This principle, often summarised as "do no harm," directs healthcare providers to avoid causing harm and to minimise risks associated with treatment.
4. Justice: Justice requires the fair distribution of healthcare resources, addressing the need for equitable access to care, particularly in resource-limited settings.

These principles are interrelated and must be balanced, as they do not operate hierarchically. Ethical decision-making involves navigating conflicts where one principle may take precedence over others depending on the context.

Ethical theories provide additional frameworks for understanding these principles:

• Deontology emphasises adherence to rules and duties regardless of the outcomes. In the context of PCa, this theory highlights the moral obligations healthcare providers have towards their patients.
• Utilitarianism focuses on actions that maximise overall benefit while minimising harm. This approach is often used in healthcare policy to evaluate cost-effectiveness and resource allocation.

Balancing affordability and efficacy are critical issues in PCa care. The practice of medical paternalism, where doctors make decisions based on what they believe is in the patient's best interest, can sometimes undermine patient autonomy. While traditional paternalism has been criticised for reinforcing power imbalances, 'soft paternalism' offers a middle ground by gently guiding patients while respecting their autonomy.

The principle of double effect also plays a role in cancer care, where treatments like chemotherapy aim to improve patient outcomes but may also cause significant side effects. Similarly, palliative care practices, such as administering morphine, can alleviate pain but may accelerate death, demonstrating the complexity of balancing positive and negative outcomes.

In South Africa, the cancer burden has increased as deaths from infectious diseases have decreased. However, inadequate funding for non-communicable diseases like cancer exacerbates treatment disparities, creating a two-tiered system with limited access to advanced therapies for many patients. The ethical challenge lies in addressing these disparities while managing the high costs of new treatments.

Cancer screening, particularly for PCa, raises ethical questions about overdiagnosis and unnecessary treatments. In regions where PCa disproportionately affects certain populations, targeted screening strategies could help address disparities and improve outcomes.

As advances in cancer treatment continue, healthcare professionals must navigate the ethical complexities of balancing efficacy with affordability. The principles of medical ethics offer a crucial framework for making decisions that prioritise patient welfare while addressing resource limitations.

To watch a replay of the webinar, click here.

The webinar is accredited for one (1) ethics point. Once you have watched the replay, send an e-mail to john.woodford@newmedia.co.za and request to have your point allocated to your profile on the HPCSA database. Include the webinar name and your HPCSA number in your e-mail.