Table 2 Summary of ethical issues/dilemmas and their resolution mechanisms

- Paternalism ; some patients’ decision making was made by their physician

- Individual consultation

- Informed consent; Lack of comprehension in certain cases due to difficulty in translating technical terms by HCPs made informed consent invalid

- Individual consultation

- Inadequate privacy due to high patient volumes and limited space to accommodate all of them

- Clinical departmental meetings

- Core management meetings

Encountered ethical dilemmas

Resolution mechanisms

- Conflicting beliefs and values driven by religion, culture and interpersonal relationships

- Individual consultation

- Tumor Board meetings

- Clinical departmental meetings

- Truth-telling to patients versus benevolent deception

- Tumor Board meetings

- Individual consultation

- Clinical departmental meetings

- Power imbalance; Some ethical dilemmas that involved heads of department (HODs) were not reported as it is the same HODs that made up the forums where these dilemmas were resolved.

- Individual consultation

- Rationing resources; Fair distribution of limited resources among a large population of cancer patients was complex for some UCI staff.

- Clinical departmental meetings

- Individual consultation

- Core management meetings

Key definitions

Ethical issues: Situations expected to arise as a matter of routine in our practice, a great majority of them allowing for straightforward decision making, because the “right” answer has been made clear through clear-cut guidelines [5].

Ethical dilemmas: A complicated situation that when two or more ethical principles, values, beliefs or standards are conflicting with each other, making decision making difficult [29].