Parental Refusal of Treatment
A 7-year-old boy is being treated for medulloblastoma, a type of brain tumor. He has had surgery and is due to start a treatment protocol that involves radiotherapy and chemotherapy. His parents (who were married at the time of his birth) are now separated, and although his father agrees to the treatment protocol, his mother is strongly opposed to radiotherapy. She is very worried about the impact it may have on surrounding brain tissue, citing evidence that it may reduce his IQ and make him infertile. The treating team is worried that his chances of survival will be much decreased if he does not have radiotherapy, which has been shown to increase the chance of disease-free survival from 35% to 80%.
His mother wants to explore other treatment options, including an alternative form of radiotherapy called proton beam irradiation (which is not recommended for this type of tumor in this country) or using hyperbaric oxygen rather than any form of radiotherapy. The clinicians are very worried that any delay in treatment will reduce the chances of the radiotherapy being successful. They have sought a second opinion from a pediatric oncology team in a separate hospital, who are wholly in agreement with their treatment plan.
- If parents refuse treatment for their child against doctors’ advice, how should we decide whether or not to proceed with treatment?
- Does it matter whether it is one parent or both who are opposed to treatment?
- Does it make any difference if they are divorced or separated?
Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)
Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme
