This scenario presents a professional challenge due to the need to balance timely diagnostic investigation with patient safety and the ethical imperative to obtain informed consent. The oncologist must consider the potential risks and benefits of different biopsy techniques, the patient’s specific clinical context, and the legal and ethical requirements surrounding medical procedures. Careful judgment is required to select the most appropriate method that minimizes harm while maximizing diagnostic yield. The best approach involves a thorough discussion with the patient regarding the proposed biopsy, including the rationale for the procedure, the specific technique being considered, potential risks and benefits, alternative options, and the expected outcomes. This discussion should be documented and confirm the patient’s understanding and voluntary agreement to proceed. This aligns with the fundamental ethical principles of autonomy and beneficence, as well as the legal requirement for informed consent in Australia, as guided by professional bodies like the Royal Australasian College of Physicians and relevant state/territory legislation. Obtaining informed consent ensures the patient is empowered to make decisions about their own healthcare. Proceeding with a biopsy without a comprehensive discussion about the specific technique and its implications fails to uphold the principle of autonomy. Patients have a right to understand what is being done to them and to consent to it. This approach risks violating the patient’s right to self-determination and could lead to legal or ethical challenges. Choosing a biopsy technique based solely on the oncologist’s personal preference or perceived ease of performance, without adequately considering the patient’s individual circumstances, risks, and alternatives, is ethically problematic. It prioritizes the clinician’s convenience over the patient’s well-being and right to informed decision-making. Performing the biopsy without any discussion of the procedure, assuming the patient implicitly consents by agreeing to further investigation, is a significant ethical and legal failing. This constitutes a breach of the duty of care and the requirement for explicit informed consent, potentially leading to accusations of battery. Professionals should employ a decision-making framework that prioritizes patient-centred care. This involves: 1. Assessing the clinical need and potential diagnostic yield of a biopsy. 2. Evaluating the risks and benefits of different biopsy techniques in the context of the patient’s specific condition and anatomy. 3. Engaging in open and honest communication with the patient, explaining the proposed procedure, alternatives, risks, and benefits in clear, understandable language. 4. Ensuring the patient has sufficient information to provide voluntary and informed consent. 5. Documenting the consent process thoroughly. 6. Selecting the biopsy technique that best balances diagnostic accuracy with patient safety and comfort.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the potential benefits of early cancer detection with the risks of overdiagnosis and overtreatment, all within the context of patient autonomy and resource allocation. The oncologist must navigate complex ethical considerations and adhere to evidence-based guidelines while respecting the patient’s individual circumstances and preferences. Correct Approach Analysis: The best professional practice involves a thorough discussion with the patient about the evidence for and against screening, considering their personal risk factors, family history, and values. This approach aligns with the principles of shared decision-making, a cornerstone of ethical medical practice. It respects patient autonomy by ensuring they are fully informed and can make a choice that reflects their own priorities. Furthermore, it adheres to the spirit of evidence-based medicine, which advocates for screening only when there is clear benefit and minimal harm, as outlined in guidelines from bodies like the National Health and Medical Research Council (NHMRC) in Australia, which emphasize the importance of informed consent and patient-centred care in screening programs. Incorrect Approaches Analysis: Recommending screening solely based on the patient’s age and general desire for “prevention” without a detailed discussion of risks and benefits fails to uphold the principle of informed consent. This approach risks leading to overdiagnosis and overtreatment, causing unnecessary anxiety, financial burden, and potential harm from invasive procedures or treatments for cancers that may never have caused clinical problems. It also disregards the specific evidence base for the proposed screening modality. Suggesting screening without considering the patient’s individual risk factors or family history is also professionally unacceptable. Screening guidelines are often stratified based on risk, and applying them indiscriminately can lead to inefficient use of healthcare resources and expose individuals to risks without a commensurate benefit. This deviates from a personalised, evidence-informed approach to cancer prevention. Refusing to discuss screening options altogether, even when the patient expresses interest, is paternalistic and undermines patient autonomy. While it is crucial to guide patients towards evidence-based decisions, outright refusal to engage in a discussion about screening, especially when the patient is seeking information, is not ethically justifiable and fails to provide appropriate medical guidance. Professional Reasoning: Professionals should employ a decision-making framework that prioritises shared decision-making. This involves: 1. Assessing the patient’s individual risk factors and relevant medical history. 2. Presenting the evidence for and against the proposed screening test, including its benefits, harms, accuracy, and limitations. 3. Discussing the patient’s values, preferences, and concerns regarding screening and potential outcomes. 4. Collaboratively deciding on the most appropriate course of action, which may include screening, alternative surveillance strategies, or no screening at this time. This process ensures that decisions are personalised, evidence-based, and ethically sound.

This scenario presents a professionally challenging situation due to the inherent uncertainty in predicting treatment response and the potential for significant patient morbidity associated with aggressive surgical intervention. The oncologist must balance the desire for maximal local control with the patient’s quality of life and the realistic likelihood of achieving a cure. Careful judgment is required to avoid both under-treatment and over-treatment. The best professional approach involves a multidisciplinary team discussion to formulate a comprehensive treatment plan. This approach is correct because it aligns with established principles of evidence-based medicine and ethical patient care. Specifically, it ensures that all available diagnostic information, including imaging, pathology, and molecular markers, is reviewed by experts from surgery, medical oncology, radiation oncology, and pathology. This collaborative process allows for a consensus on the optimal sequencing of therapies, consideration of neoadjuvant or adjuvant treatments, and a shared understanding of the risks and benefits of surgical resection in the context of the patient’s overall prognosis. This adheres to the spirit of shared decision-making and the professional obligation to provide the highest standard of care, as implicitly guided by professional bodies like the Royal Australasian College of Physicians and relevant Australian medical guidelines that emphasize collaborative patient management. An incorrect approach would be to proceed with radical surgery without a thorough multidisciplinary review. This fails to leverage the collective expertise of the oncology team, potentially leading to suboptimal surgical planning or an inappropriate surgical approach given the patient’s specific tumour biology and systemic disease status. It risks unnecessary surgical morbidity and may not offer the best chance of long-term survival. Another incorrect approach is to solely rely on the initial pathological findings and proceed with surgery without considering neoadjuvant therapy. This overlooks the potential benefits of downstaging the tumour, improving resectability, and potentially reducing the extent of surgery required, thereby improving functional outcomes. It also fails to consider the role of systemic therapy in addressing micrometastatic disease early. A further incorrect approach would be to defer definitive surgical management indefinitely based on the initial assessment, without a clear plan for ongoing monitoring or alternative treatment strategies. This could lead to disease progression and loss of the opportunity for curative intent surgery, potentially impacting the patient’s prognosis and quality of life. The professional reasoning framework for such situations involves a systematic evaluation of the patient’s clinical presentation, tumour characteristics, and patient-specific factors. This includes a thorough review of all diagnostic data, consultation with relevant specialists within a multidisciplinary team, exploration of all evidence-based treatment options, and open communication with the patient regarding the risks, benefits, and uncertainties of each approach to facilitate shared decision-making.

This scenario presents a professionally challenging situation due to the inherent uncertainty in predicting treatment response and the potential for significant toxicity in advanced cancer. The oncologist must balance the desire to offer potentially curative treatment with the need to avoid undue harm and respect the patient’s autonomy and quality of life. Careful judgment is required to navigate these competing considerations, ensuring that the treatment plan is not only medically sound but also ethically defensible and aligned with the patient’s values. The best approach involves a comprehensive shared decision-making process that prioritizes understanding the patient’s goals of care and values. This includes a thorough discussion of the proposed treatment’s potential benefits, risks, and alternatives, presented in a clear and understandable manner. Crucially, it necessitates actively eliciting and integrating the patient’s preferences, concerns, and understanding of their prognosis into the treatment plan. This aligns with the ethical principles of patient autonomy and beneficence, as well as the Australian Medical Association’s (AMA) Code of Ethics, which emphasizes the importance of informed consent and respecting a patient’s right to make decisions about their own healthcare. Furthermore, it reflects the principles of person-centred care advocated by the Australian Commission on Safety and Quality in Health Care. An incorrect approach would be to proceed with a high-dose, potentially curative regimen without thoroughly exploring the patient’s understanding of their prognosis and their personal priorities regarding treatment intensity versus quality of life. This fails to uphold the principle of patient autonomy, as the decision is not truly shared if the patient’s values are not adequately understood or incorporated. It also risks violating the principle of non-maleficence if the patient would have preferred a less aggressive approach with fewer side effects, even if it meant a lower chance of cure. Another incorrect approach would be to unilaterally decide on a palliative-only strategy based solely on the patient’s age and a general understanding of their disease stage, without engaging in a detailed discussion about their specific goals and willingness to tolerate treatment side effects. This paternalistic approach undermines patient autonomy and may not reflect the patient’s own desires for aggressive treatment if they are willing and able to tolerate it. Finally, an incorrect approach would be to present the treatment options as a fait accompli, with little room for patient input or negotiation. This bypasses the essential elements of informed consent and shared decision-making, treating the patient as a passive recipient of care rather than an active participant in their treatment journey. This is ethically unacceptable and contrary to contemporary medical practice guidelines in Australia. The professional reasoning framework for such situations should involve a structured approach: first, accurately assess the patient’s medical condition and prognosis; second, identify all medically appropriate treatment options, including their respective risks and benefits; third, engage in open and honest communication with the patient, exploring their values, goals, and preferences; fourth, collaboratively develop a treatment plan that aligns with both medical evidence and the patient’s expressed wishes; and fifth, ensure ongoing review and adaptation of the plan as the patient’s condition or preferences evolve.

The review process indicates a scenario where a junior clinical oncologist is presented with a patient diagnosed with a rare and aggressive form of cancer, for whom standard treatment protocols have shown limited efficacy. The patient, who is cognitively impaired due to their condition, has a family member acting as a surrogate decision-maker. The challenge lies in navigating the ethical and legal complexities of obtaining informed consent for an experimental treatment, balancing the patient’s best interests with their diminished capacity and the family’s involvement. This situation is professionally challenging because it requires careful judgment to uphold patient autonomy as much as possible, ensure the surrogate decision-maker is acting appropriately, and adhere to the principles of beneficence and non-maleficence within the Australian regulatory framework governing medical practice and research. The best approach involves a comprehensive assessment of the patient’s capacity to understand their condition and treatment options, even if limited. If the patient demonstrates any capacity, their wishes, however basic, should be respected and incorporated into the decision-making process. Simultaneously, a thorough evaluation of the surrogate decision-maker’s suitability and understanding of the patient’s values and preferences is crucial. This involves open communication with the surrogate, ensuring they are acting in the patient’s best interests and have access to all necessary information about the experimental treatment, including its potential benefits, risks, and alternatives. This approach aligns with the ethical principles of respect for persons, beneficence, and non-maleficence, and is supported by Australian medical professional guidelines that emphasize shared decision-making and the paramount importance of acting in the patient’s best interests, particularly when capacity is compromised. The process should also involve seeking ethical consultation to ensure all legal and ethical requirements for experimental treatments are met. An approach that solely relies on the surrogate decision-maker’s consent without any attempt to assess the patient’s residual capacity or involve them in the decision-making process to the extent possible is ethically flawed. This fails to uphold the principle of respect for persons and may not accurately reflect the patient’s own wishes or values, even if they are unable to articulate them fully. Furthermore, proceeding with an experimental treatment without a clear understanding of the patient’s best interests, as determined through a multi-faceted assessment, could lead to harm and violate the principle of non-maleficence. Another unacceptable approach would be to delay or withhold potentially beneficial experimental treatment due to the complexity of the situation and the patient’s impaired capacity, without exploring all avenues for informed consent and decision-making. This could be seen as a failure of beneficence, as it deprives the patient of a treatment that might offer a chance of improvement, even if experimental. The regulatory framework expects clinicians to actively seek ways to facilitate decision-making for patients with impaired capacity, rather than defaulting to inaction. Finally, an approach that prioritizes the family’s desires over the patient’s best interests, or fails to ensure the family fully understands the implications of the experimental treatment, is ethically unacceptable. This undermines the surrogate’s role and can lead to decisions that are not aligned with the patient’s values or well-being. The professional reasoning framework for such situations should involve a systematic process: first, assess the patient’s capacity for decision-making, documenting findings thoroughly. Second, if capacity is impaired, identify and assess the most appropriate surrogate decision-maker, ensuring they understand their role and the patient’s values. Third, engage in open and transparent communication with both the patient (to the extent of their capacity) and the surrogate, providing comprehensive information about all treatment options, including risks, benefits, and alternatives. Fourth, consult with colleagues, ethics committees, or legal counsel when navigating complex ethical or legal issues, particularly concerning experimental treatments. Finally, document all discussions, assessments, and decisions meticulously.

Scenario Analysis: This scenario presents a common and professionally challenging situation in oncology where a patient’s wishes, while clearly articulated, may conflict with established clinical guidelines or potential treatment benefits. The challenge lies in balancing patient autonomy with the clinician’s duty of care, ensuring informed consent, and navigating potential psychological distress for both the patient and their family. The oncologist must consider the patient’s capacity to make such decisions, the potential for reversible factors influencing their choice, and the ethical imperative to act in the patient’s best interest while respecting their fundamental right to self-determination. Correct Approach Analysis: The best professional approach involves a comprehensive assessment of the patient’s decision-making capacity and the underlying reasons for their request. This includes a thorough discussion to ensure the patient fully understands the implications of their decision, the potential benefits and harms of all available treatment options (including palliative care), and any reversible factors that might be influencing their current stance. This approach aligns with the ethical principles of patient autonomy and beneficence, as enshrined in Australian medical practice guidelines and the Medical Board of Australia’s Good Medical Practice: Code of Conduct for Doctors. It prioritises open communication, shared decision-making, and ensuring the patient’s decision is informed and voluntary, thereby upholding their right to refuse treatment. Incorrect Approaches Analysis: One incorrect approach involves immediately acceding to the patient’s request without further investigation. This fails to uphold the clinician’s duty of care to explore all avenues for potential benefit and to ensure the patient’s decision is fully informed. It bypasses the crucial step of assessing capacity and understanding the rationale behind the request, potentially leading to a suboptimal outcome for the patient if their decision is based on misinformation or transient emotional distress. Another incorrect approach is to dismiss the patient’s request outright due to a perceived conflict with standard treatment protocols. This disregards the fundamental principle of patient autonomy and the right to refuse treatment, even if that treatment is considered standard of care. Such an approach can lead to a breakdown in the doctor-patient relationship, erode trust, and potentially result in the patient seeking care elsewhere or feeling disempowered. A further incorrect approach involves solely focusing on the potential for treatment success without adequately exploring the patient’s quality of life concerns and their personal values. While aiming for cure or remission is a primary goal, it must be balanced with the patient’s lived experience and their definition of a meaningful life. Ignoring these aspects can lead to treatments that impose significant burdens without a commensurate improvement in the patient’s overall well-being, as perceived by the patient themselves. Professional Reasoning: Professionals should employ a structured decision-making framework that prioritises patient-centred care. This involves: 1) Establishing rapport and open communication. 2) Assessing the patient’s understanding of their condition and treatment options. 3) Evaluating decision-making capacity, considering factors like age, cognitive function, and presence of distress. 4) Exploring the patient’s values, goals, and preferences. 5) Discussing all available options, including risks, benefits, and alternatives, with a focus on shared decision-making. 6) Documenting the discussion and the patient’s decision meticulously. 7) Seeking multidisciplinary input when complex ethical or clinical issues arise.

The scenario presents a common yet complex challenge in clinical oncology: managing a patient with a newly diagnosed, aggressive malignancy where the tumor microenvironment plays a significant role in treatment resistance. The professional challenge lies in balancing the urgency of initiating effective treatment with the need for a comprehensive, evidence-based approach that considers all relevant biological factors. Misinterpreting or inadequately addressing the tumor microenvironment can lead to suboptimal treatment selection, delayed response, and potentially poorer patient outcomes. Careful judgment is required to integrate complex biological data into actionable clinical decisions within the established ethical and regulatory framework for patient care. The best approach involves a thorough, multi-modal assessment of the tumor microenvironment to inform personalized treatment strategies. This includes detailed histopathological analysis, consideration of molecular profiling for actionable targets within the tumor and its surrounding stroma, and potentially advanced imaging techniques that can provide insights into the immune cell infiltration and vascularization. This comprehensive evaluation allows for the selection of therapies that are most likely to overcome resistance mechanisms inherent to the specific tumor microenvironment, aligning with the principles of evidence-based medicine and patient-centred care. This approach is ethically justified by the duty of beneficence and non-maleficence, ensuring that treatment is tailored to the individual patient’s biological context to maximise benefit and minimise harm. It also adheres to professional guidelines that advocate for precision medicine and the use of all available diagnostic tools to optimise therapeutic outcomes. An approach that relies solely on standard chemotherapy without investigating the tumor microenvironment’s specific characteristics fails to leverage advancements in understanding cancer biology and personalized medicine. This can lead to the selection of treatments that are less effective or associated with unnecessary toxicity, representing a potential failure to provide the best available care and potentially violating the principle of beneficence. Focusing exclusively on experimental therapies without a clear rationale derived from the tumor microenvironment’s specific features, or without adequate ethical and regulatory approval for such trials, is also professionally unacceptable. This could expose the patient to unproven risks without a strong scientific basis for potential benefit, contravening the principles of non-maleficence and responsible research conduct. An approach that prioritises rapid treatment initiation over a complete diagnostic workup, even if the tumor appears aggressive, risks overlooking critical biological information that could significantly alter treatment selection and improve outcomes. While timeliness is important, it should not come at the expense of a thorough and informed decision-making process. This could be seen as a failure to exercise due diligence in patient management. The professional reasoning framework for such situations should involve a systematic evaluation: 1. Comprehensive Data Gathering: Ensure all relevant diagnostic information, including detailed histopathology, molecular profiling, and any available imaging data pertaining to the tumor microenvironment, is collected and interpreted. 2. Multidisciplinary Team Review: Discuss the case with colleagues from pathology, radiology, medical oncology, and potentially other specialties to gain a holistic understanding of the tumor and its microenvironment. 3. Evidence-Based Treatment Planning: Identify treatment options supported by current evidence, considering how they might interact with or overcome the identified features of the tumor microenvironment. 4. Patient-Centred Decision Making: Engage the patient in shared decision-making, explaining the rationale behind the proposed treatment plan, including the role of the tumor microenvironment, and addressing their values and preferences. 5. Ongoing Monitoring and Adaptation: Continuously monitor the patient’s response to treatment and be prepared to adapt the strategy based on evolving clinical and biological data.

This scenario presents a professional challenge due to the inherent uncertainty in interpreting germline genetic testing results in the context of a patient’s cancer diagnosis and family history. The oncologist must balance the immediate clinical needs of the patient with the broader implications of genetic information for family members, while adhering to strict privacy and consent principles. Careful judgment is required to ensure that the patient’s autonomy is respected and that any cascade testing is conducted ethically and appropriately. The best professional approach involves a comprehensive pre-test genetic counselling session. This session should thoroughly explain the potential benefits and limitations of germline genetic testing, including the possibility of identifying hereditary cancer predisposition syndromes. It should also clearly outline the implications of positive, negative, and uncertain results for the patient and their at-risk relatives, and importantly, discuss the process for obtaining informed consent for testing and for sharing results with family members, respecting the patient’s wishes regarding disclosure. This approach aligns with the ethical principles of beneficence, non-maleficence, and patient autonomy, and is supported by guidelines from professional bodies such as the Royal Australasian College of Physicians (RACP) which emphasize shared decision-making and comprehensive patient education. An incorrect approach would be to proceed with germline genetic testing without adequate pre-test counselling. This fails to uphold the principle of informed consent, as the patient may not fully understand what they are agreeing to or the potential consequences of the test. It also neglects the oncologist’s duty of care to ensure the patient is prepared for all possible outcomes, including the emotional and psychological impact of a positive result. Another unacceptable approach is to unilaterally disclose potential genetic findings to family members without the patient’s explicit consent. This constitutes a breach of patient confidentiality and privacy, violating fundamental ethical and legal obligations. The patient has the right to control who receives information about their health, including genetic predispositions. Finally, ordering germline genetic testing solely based on a family history without a thorough discussion of the patient’s understanding, preferences, and the potential implications for their own management and their family’s health is also professionally deficient. While family history is a crucial indicator, the decision to test must be a shared one, grounded in comprehensive counselling and respect for the patient’s values. The professional reasoning framework for such situations should involve a systematic approach: 1. Assess the clinical indication for germline testing. 2. Provide comprehensive, unbiased genetic counselling, ensuring understanding of potential results and implications. 3. Obtain explicit, informed consent for testing. 4. Discuss and plan for the management of results, including potential implications for family members and the process for cascade testing if desired by the patient and their relatives. 5. Respect patient autonomy and confidentiality at all stages.

Scenario Analysis: This scenario is professionally challenging because it requires the oncologist to balance the patient’s immediate desire for information with the ethical imperative to provide accurate and contextually appropriate information about the complex and often uncertain mechanisms of carcinogenesis. Misinformation or oversimplification can lead to undue anxiety, false hope, or a misunderstanding of the disease’s nature, impacting treatment adherence and patient well-being. The challenge lies in translating complex scientific concepts into understandable terms without sacrificing accuracy or causing distress. Correct Approach Analysis: The best professional approach involves tailoring the explanation of carcinogenesis to the patient’s current understanding and emotional state, using clear, non-technical language, and focusing on the most relevant known factors for their specific cancer type. This approach prioritizes patient comprehension and empowerment, aligning with the ethical principles of informed consent and patient-centred care. By focusing on the patient’s capacity to understand and their immediate concerns, the oncologist can provide information that is both relevant and digestible, fostering trust and facilitating shared decision-making. This aligns with the Royal Australasian College of Physicians’ (RACP) commitment to ethical medical practice, which emphasizes clear communication and respect for patient autonomy. Incorrect Approaches Analysis: Providing a comprehensive, textbook-level lecture on all known molecular pathways of carcinogenesis, regardless of the patient’s comprehension or emotional readiness, is professionally unacceptable. This approach fails to consider the patient’s individual needs and can overwhelm them with complex, abstract information, leading to confusion and anxiety. It neglects the ethical duty to communicate effectively and empathetically. Focusing solely on genetic mutations without acknowledging the role of environmental factors or cellular repair mechanisms presents an incomplete picture of carcinogenesis. This oversimplification can lead to a misunderstanding of the multifactorial nature of cancer and may inadvertently imply that cancer is purely a matter of “bad luck” or individual genetic predisposition, potentially impacting the patient’s perception of modifiable risk factors or the complexity of treatment. Dismissing the patient’s questions about the origins of their cancer as unimportant or too complex to discuss is ethically indefensible. This approach undermines patient autonomy and the right to understand their condition. It creates a barrier to trust and can leave the patient feeling disempowered and uninformed, contrary to the RACP’s emphasis on patient engagement and shared decision-making. Professional Reasoning: Professionals should adopt a patient-centred communication framework. This involves: 1) Assessing the patient’s current understanding and readiness to learn. 2) Using clear, simple language, avoiding jargon. 3) Explaining concepts in a step-wise manner, checking for comprehension frequently. 4) Tailoring the depth of information to the patient’s expressed interest and capacity. 5) Acknowledging uncertainty where it exists. 6) Focusing on information relevant to the patient’s specific situation and treatment. 7) Being prepared to revisit topics as the patient’s understanding and needs evolve.

This scenario presents a professionally challenging situation due to the inherent uncertainties in predicting a patient’s response to novel immunotherapies and the ethical imperative to balance potential benefit against the risk of severe adverse events. The oncologist must navigate complex clinical data, patient preferences, and the evolving understanding of tumor immunology, all within the framework of responsible medical practice. The best approach involves a comprehensive, shared decision-making process that prioritises patient autonomy and informed consent. This entails a thorough review of the latest clinical trial data, including efficacy rates, response durations, and the spectrum and management of potential immune-related adverse events (irAEs) specific to the proposed immunotherapy. Crucially, this information must be communicated to the patient in a clear, understandable manner, allowing them to weigh the potential benefits against the risks and their personal values. The oncologist should actively solicit the patient’s goals of care, their understanding of the treatment, and their tolerance for uncertainty and potential toxicity. This collaborative discussion forms the bedrock of ethical medical practice, ensuring the chosen treatment aligns with the patient’s wishes and best interests, and adheres to the principles of beneficence and non-maleficence. An incorrect approach would be to proceed with immunotherapy solely based on a favourable response in a similar patient population without a detailed discussion of the specific risks and benefits with the current patient. This fails to uphold the principle of informed consent, as the patient is not fully apprised of their individual risk-benefit profile. Another incorrect approach would be to defer the decision entirely to the patient without providing sufficient, tailored information about the immunotherapy and its potential consequences, thereby placing an undue burden of complex medical decision-making on an uninformed individual. Finally, initiating immunotherapy without a clear plan for monitoring and managing potential irAEs, or without considering the patient’s overall health status and potential for complications, represents a failure in due diligence and patient safety, potentially violating the principle of non-maleficence. Professionals should employ a structured decision-making framework that begins with a thorough clinical assessment, followed by an open and transparent discussion of all available treatment options, including the rationale for recommending immunotherapy. This discussion should be tailored to the patient’s comprehension level and incorporate their values and preferences. The framework should also include a robust plan for ongoing monitoring, management of anticipated toxicities, and contingency planning for treatment failure or progression.