Case 23: Refusal of Life-Sustaining Treatment By a Minor
Hopefully, you all have briefed yourselves on the case, but if you haven't, here is what is going on: There is an 11 year old boy with lymphoma that, without chemo, would kill him in 6 months, or 3-6 months additionally to live with the chemo. Also, he has a neurological disease that will eventually take all control of his walking function, talking, use of his hands, and excretory functions that would eventually kill him by the age of 18 even without the lymphoma. The problem is that he has decided that he does not want to go through with the treatment, but his parents overruled his decision and asked the doctors to continue with the chemotherapy. The questions that are posed are: should minors of Jimmy's age be able to make their own decisions that affect their lives? And should the parents' or the child's decision be the final decision? If you were the oncologist, how would you approach the situation? The important moral values that are addressed in this case are Respect for Persons, Nonmaleficence, and Responsibility. Should the child's wishes be respected? Is it doing the least harm to allow the parents to make this decision for their child? Is an 11 year old child ready to take on this responsibility?
From a Kantian point of view, the child should be the one to decide. The parents would be making this decision to satisfy their own need to be with the child longer. They would be using the child as a means to their own ends. From a utilitarian perspective, it is a lot harder to decide which would maximize pleasure and minimize the pain. It is hard to put a value on denying your child's wishes, or on discontinuing life-extending treatment for your child.
Personally, if I were the doctor, I would allow the parent's decision to be final decision, but would encourage the parents to take the decision of the child into account. I make this decision based on physiology. Physiologically, a child's prefrontal cortex, the part of the brain that controls planning, understanding future consequences, and weighing benefits and consequences, is not even remotely fully developed. He/she may have to think about things that most 11 year olds don't have to think about, but I do not believe that they can ever fully understand the consequences of discontinuing treatment. The objections that can be made about my decision may vary. One may be that even a child should have the ability to control his or her destiny and it is the child's decision. Although he/she may not be completely developed, the child has been facing death for a long time now, and ultimately knows that death is imminent.
So the questions that I pose to you: If you were the child, would you want your parents to allow you to make this decision for yourself? Would you understand that your parents just want more time with you and would you go through with it just for them?
If you were the doctor, would you speak up and say something? Is it really your place to say something? If so, how would you bring it up and in what situation?
Would it be different if the disease that the child was suffering from was different? Does it matter that the chances of the treatment working are not so great?
This situation is very difficult. Parents usually make all decisions regarding minors until they reach the age of 18. This does not always seem right. If I were the child I would want to make my own decision. 11 is a young age but I believe this child is old enough to understand what type of misery he would be in if he did reach the age of 18. He would be totally dependent on his parents. All of the problems he would have to endure throughout life would most likely cause stress and exhaustion on both him and his parents. It would be better to enjoy this child while he has time left on this earth rather than exhaust all medical options that will ultimately end in death. If I were the doctor I think I would let the family make the decision. It is very important that the parents and the child both agree on a decision. However if I was the parent of this child I may want him to go ahead with the treatment because I would hope that in the future something may change that would allow him to live a healthy normal life. Overall I think it still should be the childs decision because the pain the parents will endure because of his death should not be the factor that forces the child to participate in treatment.
In this situation I would have to agree with the child. He needs to spend his last few months with people he loves and not be bothered with doctors offices and constant tests. I do not agree with children making their own desicions to affect their lives. If we did they wouldn't be called children rather little adults. The fact is the child's cognitive thinking is not fully developed to make adult desicions, thus giving control to his parents the adults. Unfortuanatly in this senario the parents are making him suffer through constant treatment. Even if the caner doesn't kill him the neurological disease will. So I would have to say I would not understand why my parents would put me through this pain and torment. I really don't see quality time with my parents being in constant pain and in and out of conciousness. If my parents wanted more time with me should they want me happy?
If I were the child, I would want my parents to let me make the decision for myself. I understand that a child's prefrontal cortex is not fully developed and you are not considered an adult until the age 18, but that doesn't mean all children are equally immature. I think at 11 years of age that Jimmy is old enough to have his own opinion about this situation. After all he is the one going through it, not his parents. If I were the doctor I would speak up and tell his parents I know you are scared to lose him, but he believes he is ready to go to God and would probably like to spend the time he has left with his family without any suffering. I think a lot of times people get caught up in what they want in a situation and they don't take into consideration what the person dying wants. No one wants to watch their child die, but since he's been raised in a strong religious environment I think the parents would understand, especially hearing it from someone else.
This case is very hard to decided between the parents and Jimmy. I understand where the parents are coming from wanting to have more time with their son. If I were his parent I would want the same. I also understand where Jimmy is coming from, he is probably in a large about of pain and wants his last few months alive with those he loves. I would have to side with Jimmy, although as a doctor I would want to get the family together and make sure they all agree on what is going to happen. Jimmy is being realistic about what is happening to him & I think his parents need to understand where he is coming from.
It's a tough situation that the oncologist is in but I think you have to in this situation you have to listen to what the child wants. It's his body and even though he is 11 he probably has been through more stuff then people 10 or 15 years older then him have been in so I think he deserves the right to essentially pick how he is going to die. They should make the last 6 months that he has the most comfortable possible and not force him to do a procedure the clearly wants no part of anymore.
This is tough because I am sure its hard for the parents to give up and let the child decide to discontinue treatment but on the flip side the child probably just wants to live his last few months in peace. As a Doctor, he has to follow the parents wishes but I would recommend that the parents discuss this issue with the child before deciding to continue the treatment.
I can't not imagine as a parent being put in such a situation. However, since the boy is the one experiencing the pain and treatment will only sustain his life for a short period of time I feel he should be given the decision. Although, he is young, the parents decision to make him do treatment is only putting him through unnecessary pain for little gain. However, I feel a doctor would be obliged to follow the wishes of the parents.
This is a tough decision to make. It is hard to think about being a parent in this situation. Either way, Jimmy is going to die, it is going to come down to how many months longer he will live. I would have to say I would side with Jimmy and not have any treatment. I think it is important for the doctor to explain to the family members that this is what Jimmy wants and even though he is 11, taking into consideration of his past medical history, I think that he is capable of making his own decision. If I were the doctor, I would explain to the parents that everything happens for a reason and Jimmy will be in a better place without being in as much pain.
I feel for the parents here but I think Jimmy should be the one making the final decisions even though he is only 11. He's been through so much already and only he experienced all the pain and suffering and it just seems he has a lot more of that in his future. I believe at this point they should be looking more towards comfort care than anything else that would add another 3-6 painful months to his life. No parent would ever think about losing their child or making a decision that would result in that but then again what parent would want to see their child suffer day in day out and lose all freedom to control their body and to participate in daily activities?
Jimmy is 11 years old, and that may (in most cases) be too young to make such an important decision. I think this case is an exception because Jimmy has obviously been dealing with this situation most of his life, and this kind of responsibility and emphasis on death may have lead him to have a better understanding of what death is and what life is and the balance between the two than you or I or his parents might be able to understand. I think that the doctor does have a responsibilty to inform the parents on the issue and to support and kind of stand up for Jimmy's decision. From a medical perspective, he knows the futility of the treatment when you take into consideration the quality of life that Jimmy will have and stop emphasizing the quantity. I think that the parents are being selfish in wanting to push Jimmy to take the treatment when Jimmy knows that he would rather live a short, less painful or uncomfortable life than live a slightly longer much more painful and uncomfortable life. I do think that the parents should have some input into how they go about dealing with the situation (Jimmy shouln't call all the shots), but I think that it would be incredibly selfish and detrimental to Jimmy's intrinsic autonomy if they didn't consider his oppinion at all in this decision. After all, this disease is happening to him, not them. If they put him through the treatment, he has to live with the pain and disgrace of living to be an 18 year old invalid while they get the pleasure of a few more months with their little boy. It wouldn't be fair if they put him through that so that they could keep him longer. They should consider Jimmy's TRUE best interest. In this case, I think they are confusing their own best interest with Jimmy's. If I were in this situation, I would choose to live out my life without the treatement, be it a week or 6 months. I would not stay around and deal with the pain just to make my parents happy, and I don't think that this should be asked of an 11 year old either.
Case 23: Refusal of Life-Sustaining Treatment By a Minor
ReplyDeleteHopefully, you all have briefed yourselves on the case, but if you haven't, here is what is going on: There is an 11 year old boy with lymphoma that, without chemo, would kill him in 6 months, or 3-6 months additionally to live with the chemo. Also, he has a neurological disease that will eventually take all control of his walking function, talking, use of his hands, and excretory functions that would eventually kill him by the age of 18 even without the lymphoma.
The problem is that he has decided that he does not want to go through with the treatment, but his parents overruled his decision and asked the doctors to continue with the chemotherapy.
The questions that are posed are: should minors of Jimmy's age be able to make their own decisions that affect their lives? And should the parents' or the child's decision be the final decision? If you were the oncologist, how would you approach the situation?
The important moral values that are addressed in this case are Respect for Persons, Nonmaleficence, and Responsibility. Should the child's wishes be respected? Is it doing the least harm to allow the parents to make this decision for their child? Is an 11 year old child ready to take on this responsibility?
From a Kantian point of view, the child should be the one to decide. The parents would be making this decision to satisfy their own need to be with the child longer. They would be using the child as a means to their own ends.
From a utilitarian perspective, it is a lot harder to decide which would maximize pleasure and minimize the pain. It is hard to put a value on denying your child's wishes, or on discontinuing life-extending treatment for your child.
Personally, if I were the doctor, I would allow the parent's decision to be final decision, but would encourage the parents to take the decision of the child into account. I make this decision based on physiology. Physiologically, a child's prefrontal cortex, the part of the brain that controls planning, understanding future consequences, and weighing benefits and consequences, is not even remotely fully developed. He/she may have to think about things that most 11 year olds don't have to think about, but I do not believe that they can ever fully understand the consequences of discontinuing treatment.
The objections that can be made about my decision may vary. One may be that even a child should have the ability to control his or her destiny and it is the child's decision. Although he/she may not be completely developed, the child has been facing death for a long time now, and ultimately knows that death is imminent.
So the questions that I pose to you:
If you were the child, would you want your parents to allow you to make this decision for yourself? Would you understand that your parents just want more time with you and would you go through with it just for them?
If you were the doctor, would you speak up and say something? Is it really your place to say something? If so, how would you bring it up and in what situation?
Would it be different if the disease that the child was suffering from was different? Does it matter that the chances of the treatment working are not so great?
This situation is very difficult. Parents usually make all decisions regarding minors until they reach the age of 18. This does not always seem right. If I were the child I would want to make my own decision. 11 is a young age but I believe this child is old enough to understand what type of misery he would be in if he did reach the age of 18. He would be totally dependent on his parents. All of the problems he would have to endure throughout life would most likely cause stress and exhaustion on both him and his parents. It would be better to enjoy this child while he has time left on this earth rather than exhaust all medical options that will ultimately end in death. If I were the doctor I think I would let the family make the decision. It is very important that the parents and the child both agree on a decision. However if I was the parent of this child I may want him to go ahead with the treatment because I would hope that in the future something may change that would allow him to live a healthy normal life. Overall I think it still should be the childs decision because the pain the parents will endure because of his death should not be the factor that forces the child to participate in treatment.
ReplyDeleteIn this situation I would have to agree with the child. He needs to spend his last few months with people he loves and not be bothered with doctors offices and constant tests. I do not agree with children making their own desicions to affect their lives. If we did they wouldn't be called children rather little adults. The fact is the child's cognitive thinking is not fully developed to make adult desicions, thus giving control to his parents the adults. Unfortuanatly in this senario the parents are making him suffer through constant treatment. Even if the caner doesn't kill him the neurological disease will. So I would have to say I would not understand why my parents would put me through this pain and torment. I really don't see quality time with my parents being in constant pain and in and out of conciousness. If my parents wanted more time with me should they want me happy?
ReplyDeleteIf I were the child, I would want my parents to let me make the decision for myself. I understand that a child's prefrontal cortex is not fully developed and you are not considered an adult until the age 18, but that doesn't mean all children are equally immature. I think at 11 years of age that Jimmy is old enough to have his own opinion about this situation. After all he is the one going through it, not his parents. If I were the doctor I would speak up and tell his parents I know you are scared to lose him, but he believes he is ready to go to God and would probably like to spend the time he has left with his family without any suffering. I think a lot of times people get caught up in what they want in a situation and they don't take into consideration what the person dying wants. No one wants to watch their child die, but since he's been raised in a strong religious environment I think the parents would understand, especially hearing it from someone else.
ReplyDeleteThis case is very hard to decided between the parents and Jimmy. I understand where the parents are coming from wanting to have more time with their son. If I were his parent I would want the same. I also understand where Jimmy is coming from, he is probably in a large about of pain and wants his last few months alive with those he loves. I would have to side with Jimmy, although as a doctor I would want to get the family together and make sure they all agree on what is going to happen. Jimmy is being realistic about what is happening to him & I think his parents need to understand where he is coming from.
ReplyDeleteIt's a tough situation that the oncologist is in but I think you have to in this situation you have to listen to what the child wants. It's his body and even though he is 11 he probably has been through more stuff then people 10 or 15 years older then him have been in so I think he deserves the right to essentially pick how he is going to die. They should make the last 6 months that he has the most comfortable possible and not force him to do a procedure the clearly wants no part of anymore.
ReplyDeleteThis is tough because I am sure its hard for the parents to give up and let the child decide to discontinue treatment but on the flip side the child probably just wants to live his last few months in peace. As a Doctor, he has to follow the parents wishes but I would recommend that the parents discuss this issue with the child before deciding to continue the treatment.
ReplyDeleteI can't not imagine as a parent being put in such a situation. However, since the boy is the one experiencing the pain and treatment will only sustain his life for a short period of time I feel he should be given the decision. Although, he is young, the parents decision to make him do treatment is only putting him through unnecessary pain for little gain. However, I feel a doctor would be obliged to follow the wishes of the parents.
ReplyDeleteThis is a tough decision to make. It is hard to think about being a parent in this situation. Either way, Jimmy is going to die, it is going to come down to how many months longer he will live. I would have to say I would side with Jimmy and not have any treatment. I think it is important for the doctor to explain to the family members that this is what Jimmy wants and even though he is 11, taking into consideration of his past medical history, I think that he is capable of making his own decision. If I were the doctor, I would explain to the parents that everything happens for a reason and Jimmy will be in a better place without being in as much pain.
ReplyDeleteI feel for the parents here but I think Jimmy should be the one making the final decisions even though he is only 11. He's been through so much already and only he experienced all the pain and suffering and it just seems he has a lot more of that in his future. I believe at this point they should be looking more towards comfort care than anything else that would add another 3-6 painful months to his life. No parent would ever think about losing their child or making a decision that would result in that but then again what parent would want to see their child suffer day in day out and lose all freedom to control their body and to participate in daily activities?
ReplyDeleteJimmy is 11 years old, and that may (in most cases) be too young to make such an important decision. I think this case is an exception because Jimmy has obviously been dealing with this situation most of his life, and this kind of responsibility and emphasis on death may have lead him to have a better understanding of what death is and what life is and the balance between the two than you or I or his parents might be able to understand. I think that the doctor does have a responsibilty to inform the parents on the issue and to support and kind of stand up for Jimmy's decision. From a medical perspective, he knows the futility of the treatment when you take into consideration the quality of life that Jimmy will have and stop emphasizing the quantity. I think that the parents are being selfish in wanting to push Jimmy to take the treatment when Jimmy knows that he would rather live a short, less painful or uncomfortable life than live a slightly longer much more painful and uncomfortable life. I do think that the parents should have some input into how they go about dealing with the situation (Jimmy shouln't call all the shots), but I think that it would be incredibly selfish and detrimental to Jimmy's intrinsic autonomy if they didn't consider his oppinion at all in this decision. After all, this disease is happening to him, not them. If they put him through the treatment, he has to live with the pain and disgrace of living to be an 18 year old invalid while they get the pleasure of a few more months with their little boy. It wouldn't be fair if they put him through that so that they could keep him longer. They should consider Jimmy's TRUE best interest. In this case, I think they are confusing their own best interest with Jimmy's. If I were in this situation, I would choose to live out my life without the treatement, be it a week or 6 months. I would not stay around and deal with the pain just to make my parents happy, and I don't think that this should be asked of an 11 year old either.
ReplyDelete