Oncology nursing is a complex world that continues to evolve rapidly. However, one challenge that remains consistent is the ethical dilemmas nurses face when caring for patients with cancer. Complex care needs and lengthy hospital stays are common in our patient population and allow opportunity for nurses to develop relationships with patients and their families. Over the course of treatment, various ethical issues may arise, which nurses are at the forefront of identifying and acting on.

The concept of providing comfort is at the core of my identity as a nurse, and I have always been drawn to the palliative care component of what we do as oncology nurses. Because it wasn’t part of my roles, I was less confident in my knowledge and understanding of chemotherapy administration, but I often thought, “Palliative care, yeah, I’ve got this!”

And then I learned how little I knew.

In nursing school I was always taught to maintain professional boundaries with patients, including never sharing any personal information like my address or contact information. No matter how many times faculty members said it, we never role played scenarios with that situation. I was unprepared for the moment, six months into my nursing career, when a kind, gentle, nonthreatening woman asked me for my address so she could send me a Christmas card.

More than engineers, accountants, professors, or police officers, nurses lead the pack when it comes to honesty and ethics, according to 2019 Gallup polling data. For 18 years in a row, nurses have been recognized as the most trusted profession in the United States—by a considerable margin, too. Ratings for nursing honesty and ethics outpaced every other profession by a wide margin, and nurses lead the next most trusted profession—engineers—by nearly 20 percentage points.

Ethical dilemmas arise more often than we realize: consider the patient you have been taking care of for three days telling you he wants no further treatment, but later goes along with family members when they push for more treatment. Moral distress occurs when nurses believe they know the correct action to take but are prevented from doing so. It may lead to a decrease in the quality of patient care and can be a causative factor when nurses leave their current job and sometimes even the profession.

Cancer knows no race, color, nationality, or ethnicity. But although any person may one day develop cancer, incidence and mortality rates for some cancers are disproportionately higher in certain racial, ethnic, geographic, or socioeconomic groups. Here are just a few of the many identified cancer disparities, according to the National Cancer Institute.

After recent a best-selling book-turned-movie detailed her story, Henrietta Lacks’ extraordinary impact on cancer research continues to become common knowledge to more people. However, many more are still unaware of how her story, struggle with cancer, and tumor cells changed the face of cancer care. For that reason, Representative Elijah Cummings (D-MD), along with a congressional delegation from both chambers, introduced legislation to both honor her role in history and improve access to medical research to traditionally underrepresented groups.

Betty, age 70, was diagnosed with metastatic colon cancer and started treatment with FOLFOX. Her medical oncologist changed the treatment to capcitabine after Betty developed grade 3 peripheral neuropathy. Because of disease progression, bevacizumab was added to her treatment plan. She lives with her daughter, is insured by Medicare, and receives $800 per month from Social Security.

Having an outlet to consider, discuss, and reflect on oncology ethical issues that affect our daily practice is important in caring for each other in our profession. On our solid tumor oncology unit, monthly nursing ethics lunch and learns allow our nurses the opportunity to identify and discuss their concerns with recent patient cases involving ethical issues. Our hospital’s ethics committee chair facilitates the hour-long discussions held on the unit, along with a senior oncology nurse with significant training and background in clinical ethics.

Roxanne, a blood and marrow transplant certified nurse, has been taking care of Jerome, a 20-year-old man diagnosed with acute myeloid leukemia. Jerome is the eldest of seven children; his mother works full-time, and with younger children at home has not been able to make the trip across country to be with her son.

The MeToo movement, an online campaign where women from all walks of life shared their stories of personal sexual assault and harassment, went viral in October 2017. The goal of their stories was to demonstrate the prevalence of sexual misconduct, especially in the workplace. Victims of sexual violence and harassment often go unnoticed and unheard, even though the World Health Organization (WHO) estimates that it affects approximately one third of women worldwide. In a 2017 poll of American women, 54% reported “unwanted and inappropriate sexual advances” and 95% said it goes unreported.

It’s 2017, and one would think that all patients are treated equally. Nursing has certainly been educated to treat all patients with the same levels of respect and dignity and to provide excellent medical care regardless of age, race, ethnicity, or religious beliefs. In the theory of nursing, I think we all strive and believe that patients should be treated equally. However, at least for the reality of nursing that I work in, that doesn’t always feel true.

Imagine a situation where a patient’s tumor cells were used for countless scientific experiments—without the patient’s informed consent. Safeguards are in place today to prevent such an ethical breach, but in 1951 Henrietta Lacks and her family weren’t as lucky. Author Rebecca Skloot shared Henrietta’s story in a 2010 nonfiction book, The Immortal Life of Henrietta Lacks, that was adapted into a movie released on April 22, 2017.