Ethical dilemmas in the management of endometriosis

After 150 years of research and quite a number of proposed hypotheses, the etiology of endometriosis remains elusive. Therefore, often endometriosis raises difficult ethical challenges in terms of establishing the diagnosis without delay and in a noninvasive manner in order to provide adequate advice and the best available treatment options. An ethical dilemma faced by the treating physician while communicating the diagnosis of endometriosis as a cause in a patient with infertility is the conflict between the patient's right to confidentiality and the partner's right to have access to the information. Therefore, in medical practice, many times it is difficult for the patients to properly comprehend the information provided to them by the physician and therefore to provide consent of being fully informed about the disease. In the case that the surgeon cannot benefit the patient from an extensive procedure, the question becomes whether or not it is ethical not to do adhesiolysis just to respect the principle of “do no harm,” because then, at the same time, surgeon is not complying with the principle of “doing good for the patient?” Some other dilemmas in clinical practice are, first, failing to diagnose extent of endometriosis preoperatively and the failure of surgical healing in case of radical surgery undertaken at the time of surgery for unexpected findings.