In paediatrics, professionals are faced with varied ethical dilemmas when dealing with patients. The paper considers an ethical dilemma, where a teen is forced to continue chemotherapy against his wish. The case is about a minor who suffers from Lymphoma, and the treatment recommended by doctors is chemotherapy. Statistics indicate that about 80-90% of cases of minor who undergo the treatment protocols are successful. Nonetheless, this data does not indicate the side effects that may arise from the treatment method. Alternative for the treatment are limited when the chemo fails.
Ethical Principles
The teen refusing to continue receiving the chemotherapy presents an ethical dilemma. This dilemma arises from the conflict that is between two ethical principles. The first one being the principle of respect for autonomy, which is the call that individuals right to self-determination must be respected. It translates that that people should be allowed to refuse medical treatment even in cases that involve lifesaving therapy (Peluso et al, 2017). The other ethical principle is the beneficence, which authorises physicians and hospital facilities to minimize harms and maximize benefits when caring for the patients.
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It might be unethical to keep providing chemotherapy treatment to the teen against his will and mothers want. Since the facility believes that this is the best treatment to cure the disease, the teen will have to undergo the process. The teen parent believes chemotherapy is toxic and has some long-term side effects. He believes this will destroy some of the teen body organs and cause harm to him in future. This might not be the true position, but studies indicate that some survivors died due to causes of unintended chemotherapy effects. Consequently, the teen and the parent are against the treatment procedure. Aware that no-treatment might lead to death, the teen had decided in his childhood that he would not prefer chemotherapy if he develops the condition.
ANA Code of Ethics Provisions
The case of this teen presents an ethical dilemma as he is still a minor under the legal provisions. Therefore, it translates that a parent or guardian is the one legally mandated to make healthcare decisions on his behalf. In this case, the parent has supported his son decision to refuse treatment. In the past, courts have overruled parent’s decision based on the state of the minor. Ronen & Rosenbaum (2017) say where the minor’s health or life is threatened; the custody is removed from the parent or guardian and a “guardian ad litem” is appointed to make medical decision on behalf of the minor. The minor must undergo the therapy against her will considering his health condition. This is because the minor has a higher chance of surviving the condition through chemotherapy.
As a leading principle physicians’ parents can make the decision for their children, however, this should not be against the child’s best interest. Ethics of such a case is difficult as the process is painful and uncomfortable, but if continued the medical treatment will save the patient. Nonetheless, it is not easy in a case where such a patient must go under the discomfort for a long period. The law allows physicians to force a long-term chemotherapy on minors in case of refusal by calling the Child Protective Services to provide a solution.
Outcomes and Plan
The minor is refusing the chemotherapy but if he gets cured, he might be grateful of a life saved. On the other hand, he might remain resentful, because his autonomous right for medical treatment was ignored (Bringedal et al, 2017). Despite his judgement, the ethical dilemma in this case is not resolved. He remains legally minor; however, this does not justify physicians’ actions. Many might disagree with the decision to violate the minor right to refuse medical treatment, however, he should be provided with the best medical care to help him out of his condition. Therefore, the plan to force treatment on the minor on moral grounds should be implemented. This incident presents a case of ethics and law. Being a minor, the patient has no case law, therefore, it is a medical decision-making issue.
Peluso et al (2017) opines that the patient might be aware of his condition, understand the treatment procedure and aware of all the risks and benefits presented by the recommended procedure. Moreover, being a teen, the patient has a strong understanding and appreciate the implications of his decision, by having a strong rational and logical reasons for his choice. Therefore, it is necessary to educate him and help him to address his fears and concerns. Nonetheless, the doctor has the best interest of the teen and his welfare.
References
Bringedal, B., Rø, K. I., Magelssen, M., Førde, R., & Aasland, O. G. (2017). Between
professional values, social regulations and patient preferences: Medical doctors perceptions of ethical dilemmas. Journal of Medical Ethics .
Peluso, M. J., Kallem, S., Elansary, M., & Rabin, T. L. (2017). Ethical dilemmas during
international clinical rotations in global health settings: Findings from a training and debriefing program. Medical Teacher , 40(1), 53-61.
Ronen, G. M., & Rosenbaum, P. L. (2017). Reflections on Ethics and Humanity in Pediatric
Neurology: The Value of Recognizing Ethical Issues in Common Clinical Practice. Current Neurology and Neuroscience Reports , 17(5).
Reflection
This case of the teen presents an ethical dilemma where a medical professional must decide on an action to take to save a patient’s life. A patient might have the right of refusal to medical treatment recommended by the doctor, but acting on the best interest of the patient, the physician or hospital facility can decide to violate this right to protect the minor’s life. People might have some cultural beliefs against some medical procedures, but this should never override a professional prescription of treatment. Morally, it is always best to consider the patients opinion before making the final medical treatment decision. This can be done by explaining to the patient on the benefits of the chosen procedure.
