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Ethical and clinical dilemmas in patients with head and neck tumors visiting a field hospital in the Philippines

Tal Marom, MD, David Segal, MD, Tomer Erlich, MD, Erez Tsumi, MD, Ofer Merin, MD, MHA, Guy Lin, MD

Abstract


Objective: To describe clinical and ethical dilemmas in patients presenting with head and neck (H&N) tumors to a field hospital in the “subacute” period following a typhoon.

Methods: We retrospectively reviewed charts of H&N patients presenting to an integrated Israeli-Filipino medical facility, which was operated more than 11 days.

Results: Of the 1,844 adult patients examined, 85 (5 percent) presented with H&N tumors. Of those, 70 (82 percent) were females, with a mean age of 43 ± 15 years. Thyroid neoplasms were the most common tumors (68, 80 percent). Despite limited resources, we contributed to the workup and treatment of several patients. To better illustrate our dilemmas, we present four key patients, in whom we favored diagnostic/therapeutic interventions in two, and opted to defer any intervention in two.

Conclusions: In a relief mission, despite the lack of clinical and pathological staging and questionable continuity of care, surgical interventions can be considered for therapeutic, palliative, and diagnostic purposes.


Keywords


field hospital, head and neck tumors, clinical ethics

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References


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DOI: https://doi.org/10.5055/ajdm.2014.0172

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