Australian court rules that 6 year old with brain cancer should be treated palliatively

[snkdy]

...in accordance with the parents' wishes.

http://www.abc.net.au/news/2016-09-...ancer-win-court-battle-over-treatment/7805138

Thoughts?

---

Members don't see this ad.

 

[ERDOC555]

If I read this correctly:

Treatment would give the child a 50-60% chance of long term survival, parents sued to ensure 0% survival, and a judge said, "ok, fine, let your child die without treatment, but just for this one case, not a precedent"

Assuming I didn't miss something I think that's completely messed up. 5% chance would be one thing, over 50% chance to live a long healthy life seems like a no-brainer to treat.

 

[snkdy]

If I read this correctly:

Treatment would give the child a 50-60% chance of long term survival, parents sued to ensure 0% survival, and a judge said, "ok, fine, let your child die without treatment, but just for this one case, not a precedent"

Assuming I didn't miss something I think that's completely messed up. 5% chance would be one thing, over 50% chance to live a long healthy life seems like a no-brainer to treat.

Yes, the 50-60% survival rate referred to both chemo and radiation therapy. They were forced to agree to the former in March and then refused to do the latter when the doctors recommended it. They seem more concerned about cognitive impairment than anything else.

 

[Psai]

50-60% chance of living for 5 years after an expensive and stressful course of treatment with risk of infection, another cancer, diarrhea, terrible rashes, hair falling out, numbness and tingling in your extremities, etc.

Just because we can treat something doesn't mean we should. People should have autonomy to choose their medical treatment. There is so much suffering going on in hospitals around the country because people just can't let go of their loved ones.

 

[snkdy]

50-60% chance of living for 5 years after an expensive and stressful course of treatment with risk of infection, another cancer, diarrhea, terrible rashes, hair falling out, numbness and tingling in your extremities, etc.

Just because we can treat something doesn't mean we should. People should have autonomy to choose their medical treatment. There is so much suffering going on in hospitals around the country because people just can't let go of their loved ones.

I agree with this in principle. But in this case, the doctors said the survival rate dropped because they delayed treatment. They wanted to try alternative medicine before they were forced into chemo by the court earlier in the year.

 

[Storph]

50-60% chance of living for 5 years after an expensive and stressful course of treatment with risk of infection, another cancer, diarrhea, terrible rashes, hair falling out, numbness and tingling in your extremities, etc.

Just because we can treat something doesn't mean we should. People should have autonomy to choose their medical treatment. There is so much suffering going on in hospitals around the country because people just can't let go of their loved ones.

Did you read the article? I agree with you when we are treating patients with little chance for survival that are facing extreme suffering with treatment, but this is not that case.

The 50-60% number they cited was not for 5 year survival, it was curative. I understand that people often cite those things as the same, but they aren't. This child wasn't expected to live through 5 years of suffering with treatment; the expectation was he would live a full life following this treatment. While I agree that patient autonomy is important, I don't think that a child's parents should have imputative autonomy when they are pushing for something that is not in the best interest of the child, which could easily be argued here.

 

[Doctor Bob]

over 50% chance to live a long healthy life seems like a no-brainer to treat.

I see what you did there...

 

[Psai]

Did you read the article? I agree with you when we are treating patients with little chance for survival that are facing extreme suffering with treatment, but this is not that case.

The 50-60% number they cited was not for 5 year survival, it was curative. I understand that people often cite those things as the same, but they aren't. This child wasn't expected to live through 5 years of suffering with treatment; the expectation was he would live a full life following this treatment. While I agree that patient autonomy is important, I don't think that a child's parents should have imputative autonomy when they are pushing for something that is not in the best interest of the child, which could easily be argued here.

Oh really? What kind of cancer is it? And what is the treatment course being recommended?

Quote from the article: "They estimated at the time that the recommended treatment would give Oshin a 50 to 60 per cent prospect of being alive in five years which, if achieved, would be regarded as a "cure"

So it's a 50-60% chance of 5 year survival which is the median on the kaplan-meier curve. Where are you getting the expectation of living a full life? Let's learn about medicine from medical texts, not your poorly done interpretation of a news reporter's understanding of cancer treatment.

Thanks for the lesson in pediatric oncology, medical student. Get back to pathoma.

 

[SurfingDoctor]

Hard to know what the right strategy is without really knowing the details.

Clearly, "alternative" treatments based on the parents perception that radation is bad, was unlikely to lead to a good outcome, but then again, hard to know if radiation (after he already had surgical resection and chemotherapy) was going to lead to a good outcome without actually knowing what the tumor histology was. 50-60% survival at 5 years is typical survival for pediatric brain tumor. It can be better; 90% in grade I astrocytomas with good surgical margins, or worse; 20% in grade IV astrocytomas. However, there certainly is a danger in parents recommending for or against therapies when they don't have a real medical understanding (eg, the whole vaccine/autism non-sense).

Either way, it is unfortunate for this little boy.

 

[911 Turbo]

People should have autonomy to choose their medical treatment.

what if there's a 99% chance to completely cure a 3 year old's terminal disease but the parent's don't want the treatment? are there laws in place which kick in at this point and give the doctor the right to provide care despite the parent's wishes?

 

[SurfingDoctor]

what if there's a 99% chance to completely cure a 3 year old's terminal disease but the parent's don't want the treatment? are there laws in place which kick in at this point and give the doctor the right to provide care despite the parent's wishes?

Yes, physicians (at least in the US) can get a court-ordered medical power of attorney for children of parents who require life saving therapies (eg, blood transfusions in children of parents who are Jehovah's Witnesses, http://adc.bmj.com/content/90/7/715.full).

The tricky part is proving that the therapy is life saving. It becomes even more tricky when you are prognosicating something like cancer outcomes with or without certain therapies based on parental or minors beliefs (http://www.ncbi.nlm.nih.gov/pubmed/21951447). However, there are a number of cases in the US (and I'm sure world-wide) where courts have removed parental rights or decision making when it came to parental refusal of medical treatment for children.

 

[Azete]

what if there's a 99% chance to completely cure a 3 year old's terminal disease but the parent's don't want the treatment? are there laws in place which kick in at this point and give the doctor the right to provide care despite the parent's wishes?

This varies by state, but yes, there are laws that allow treatment in these cases -- typically for acute illness, though, if I'm not mistaken.

Personally, in the case of cancer (even with 50-60% odds), I agree the parents should be allowed to do what they want. As a parent this wouldn't be an easy decision for me; subjecting my child to chem/rad would not be something I take lightly. Even in the best case scenario of complete remission, these treatments would have developmental effects that last a lifetime.

 

[Storph]

Oh really? What kind of cancer is it? And what is the treatment course being recommended?

Quote from the article: "They estimated at the time that the recommended treatment would give Oshin a 50 to 60 per cent prospect of being alive in five years which, if achieved, would be regarded as a "cure"

So it's a 50-60% chance of 5 year survival which is the median on the kaplan-meier curve. Where are you getting the expectation of living a full life? Let's learn about medicine from medical texts, not your poorly done interpretation of a news reporter's understanding of cancer treatment.

Thanks for the lesson in pediatric oncology, medical student. Get back to pathoma.

First off, saying things with venom doesn't make those things correct.

Second, I'm not trying to interpret the survival odds of the treatment; the board-certified pediatric oncologists are. I am just stating their interpretation. Given that they are experts in their field, and they have much more experience with this case than either you or I do, I would probly stick with what they say. But hey, maybe the intern in who knows what specialty it is knows more than they do. Go figure

 

[Psai]

First off, saying things with venom doesn't make those things correct.

Second, I'm not trying to interpret the survival odds of the treatment; the board-certified pediatric oncologists are. I am just stating their interpretation. Given that they are experts in their field, and they have much more experience with this case than either you or I do, I would probly stick with what they say. But hey, maybe the intern in who knows what specialty it is knows more than they do. Go figure

When you're wrong, feel free to admit it. It's a lot easier to get along with and teach a medical student who doesn't insist on being wrong. You were wrong. Get over it.

No one can predict the future. And when you're estimating survival, it's either from a kaplan meier curve which tells you what happened in a given population that was measured or it's a complete guess.

 

[Storph]

When you're wrong, feel free to admit it. It's a lot easier to get along with and teach a medical student who doesn't insist on being wrong. You were wrong. Get over it.

No one can predict the future. And when you're estimating survival, it's either from a kaplan meier curve which tells you what happened in a given population that was measured or it's a complete guess.

I don't see how I am wrong. I'm sure the oncologists making those interpretations knew what they were doing far better than you do. You've been an intern for what? 2 months? Don't try to lord it over people.

You're absolute mastery of dodging answers to questions is impressive though. You have no grounds to challenge the interpretations of those who know this case better than you. Don't feign omniscience

 

[Psai]

I don't see how I am wrong. I'm sure the oncologists making those interpretations knew what they were doing far better than you do. You've been an intern for what? 2 months? Don't try to lord it over people.

You're absolute mastery of dodging answers to questions is impressive though. You have no grounds to challenge the interpretations of those who know this case better than you. Don't feign omniscience

You're trying to appeal to authority. What you're saying and what the reporter said that the doctors said are two different things. We don't really "cure" cancer with the exception of things like atra for apml. It's really just a delay and what you're aiming for is disease free progression. But the sequela from treatment is significant and he's already experienced quite a bit. You're acting like toxic medication and significant radiation to the cranium and spinal cord will make this kid into a normal kid again. They're not using some magic formula from their giant cancer doctor brains to get those survival rate numbers btw. It's from a kaplan meier curve that they got from a study which basically tracks how many people died over a period of time.

Btw it's your, not you're

 

[Donald Juan]

Did you read the article? I agree with you when we are treating patients with little chance for survival that are facing extreme suffering with treatment, but this is not that case.

The 50-60% number they cited was not for 5 year survival, it was curative. I understand that people often cite those things as the same, but they aren't. This child wasn't expected to live through 5 years of suffering with treatment; the expectation was he would live a full life following this treatment. While I agree that patient autonomy is important, I don't think that a child's parents should have imputative autonomy when they are pushing for something that is not in the best interest of the child, which could easily be argued here.

A difficult treatment with 100% chance of cure is a no brainer to push patients into getting. A difficult treatment with 0% chance of cure is a no brainer at pushing them away. 50/50 is the exact middle of the two. I think any situation like this is one you have to discuss with the patients and give them some autonomy, especially when the treatment is not benign. Radiation and chemotherapy have significant impact on people both short term and long term.

 

[Stagg737]

A difficult treatment with 100% chance of cure is a no brainer to push patients into getting. A difficult treatment with 0% chance of cure is a no brainer at pushing them away. 50/50 is the exact middle of the two. I think any situation like this is one you have to discuss with the patients and give them some autonomy, especially when the treatment is not benign. Radiation and chemotherapy have significant impact on people both short term and long term.

Normally I'd agree, but do you really think a 6 year old has the capacity and general life awareness to make this decision or even give a significant opinion? I'm pretty pro-autonomy, but I'd have a pretty tough time following the wishes of a six year old.

 

[751866]

Fun fact: 50-60% chance (probability) of survival isn't the same as odds... "50%" odds would be 33% percent chance of survival (1:2 odds of survival).

 

[Psai]

Normally I'd agree, but do you really think a 6 year old has the capacity and general life awareness to make this decision or even give a significant opinion? I'm pretty pro-autonomy, but I'd have a pretty tough time following the wishes of a six year old.

That's why we should respect the parent's decisions, under the assumption that they have the patient's best wishes at heart. The ideal situation for patients is not the one where they have the most days alive just for the sake of being alive.

 

[SurfingDoctor]

That's why we should respect the parent's decisions, under the assumption that they have the patient's best wishes at heart. The ideal situation for patients is not the one where they have the most days alive just for the sake of being alive.

I will say, you do have to be careful interpreting parent wishes and the assumption that those wishes are always in the child's best interests. Personally I have seen parents demand another external ventricular drain for terminal brain cancer when the previous one failed due to untreatable tumor growth and the child would otherwise herniate from intracranial pressure. I don't fault those parents because they don't want to lose their child, but their decisions are not in the child's best interests.

The same could be said for parents refusing vaccines for their child. Their wishes are not in the child's (or society's) best interests. It not to say they don't care for their children, but their beliefs aren't grounded in reality, and unfortunately, that can cause harm.

 

[Psai]

There's a difference between putting yourself (or your kids) vs putting other people at harm by negligence

 

[SurfingDoctor]

There's a difference between negligent care to one's children versus other people? I'm not sure I understand, since negligence either way is not doing the right thing. One can make harmful decisions for their own child, but not for others? I'm just trying to understand your argument because in either case, the receiver of negligent treatment is being harmed, so why does it matter it is one's own child versus someone elses?

 

[Stagg737]

That's why we should respect the parent's decisions, under the assumption that they have the patient's best wishes at heart. The ideal situation for patients is not the one where they have the most days alive just for the sake of being alive.

These are the same parents who were previously ordered by a court to allow their child to undergo chemotherapy because they wanted to use alternative medicine to treat his cancer. Idk what the alternative treatment was, but if it was acupuncture or some diet then I find it hard to justify assuming they have the decision-making capacity to know what's best for that child.

 

[wonder12]

If I read this correctly:

Treatment would give the child a 50-60% chance of long term survival, parents sued to ensure 0% survival, and a judge said, "ok, fine, let your child die without treatment, but just for this one case, not a precedent"

Assuming I didn't miss something I think that's completely messed up. 5% chance would be one thing, over 50% chance to live a long healthy life seems like a no-brainer to treat.

No, the judge ruled this way after a drawn out battle during which he was not receiving treatment. His condition had progressed to the point where the chances of treatment being effective were "remote." Thus he ruled in favor of palliative care, so that the court battle would not further interrupt the end of the child's life. That is why the judge emphasized that this case should not be used as a precedent.

 

[Wordead]

Did you read the article? I agree with you when we are treating patients with little chance for survival that are facing extreme suffering with treatment, but this is not that case.

The 50-60% number they cited was not for 5 year survival, it was curative. I understand that people often cite those things as the same, but they aren't. This child wasn't expected to live through 5 years of suffering with treatment; the expectation was he would live a full life following this treatment. While I agree that patient autonomy is important, I don't think that a child's parents should have imputative autonomy when they are pushing for something that is not in the best interest of the child, which could easily be argued here.

A full normal life following chemorads to the head/neck.....yeah ok

 

[Psai]

A full normal life following chemorads to the head/neck.....yeah ok

No, no he's a medical student okay? You're just a resident you don't know ****

 

[Psai]

There's a difference between negligent care to one's children versus other people? I'm not sure I understand, since negligence either way is not doing the right thing. One can make harmful decisions for their own child, but not for others? I'm just trying to understand your argument because in either case, the receiver of negligent treatment is being harmed, so why does it matter it is one's own child versus someone elses?

They can put their own child at harm if they fully understand the pros and cons of their decision as it's their child.

We as a society have decided that people shouldn't put other people's children at harm through their negligence. How can you be an attending and not understand negative rights?

 

[SurfingDoctor]

They can put their own child at harm if they fully understand the pros and cons of their decision as it's their child.

We as a society have decided that people shouldn't put other people's children at harm through their negligence. How can you be an attending and not understand negative rights?

Well, I am just a lowly attending, but I understand the law regarding child welfare and what you just stated here "They can put their own child at harm if they fully understand the pros and cons of their decision" is the definition of child abuse/neglect. It is a federal crime in this country and illegal in many others. I have seen many parents willfully put their own children at risk and the courts and law did not side with them.

Here is the federal definition:

• "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation"; or
  
• "An act or failure to act which presents an imminent risk of serious harm."

In most state definitions, harm can be also considered threats or intent to harm. Likewise failure to act can be considered intentional or unintentional (ie carelessness or negligence).

Just so you know as well, if you observe child abuse or neglect and fail to report it as a medical provider because you think it is a negative right, that is also a state/federal crime. https://www.childwelfare.gov/pubPDFs/report.pdf

 

[DocWinter]

The article doesn't mention his prognosis or life expectancy without treatment, rather useful info to leave out.

What I don't get is why people are questioning the judgement of the parents. We have a layman's article here with few pertinent facts. To have the assumption the parents don't care or wouldn't do right by the child with their best judgement seems unwise.

 

[MDProspect]

The article doesn't mention his prognosis or life expectancy without treatment, rather useful info to leave out.

What I don't get is why people are questioning the judgement of the parents. We have a layman's article here with few pertinent facts. To have the assumption the parents don't care or wouldn't do right by the child with their best judgement seems unwise.

I think it's reasonable to assume that the child is going to die soon without chemo. The general assumption is that when someone chooses naturopathy or other forms of alternative medicine, they are not looking out for their child's or their own best interests.

 

[DocWinter]

I think it's reasonable to assume that the child is going to die soon without chemo. The general assumption is that when someone chooses naturopathy or other forms of alternative medicine, they are not looking out for their child's or their own best interests.

Agree, but the article just says "alternative treatments" which could mean palliative care. Again, more information please.

 

[Donald Juan]

Normally I'd agree, but do you really think a 6 year old has the capacity and general life awareness to make this decision or even give a significant opinion? I'm pretty pro-autonomy, but I'd have a pretty tough time following the wishes of a six year old.

...I meant the parents

 

[Donald Juan]

Well, I am just a lowly attending, but I understand the law regarding child welfare and what you just stated here "They can put their own child at harm if they fully understand the pros and cons of their decision" is the definition of child abuse/neglect. It is a federal crime in this country and illegal in many others. I have seen many parents willfully put their own children at risk and the courts and law did not side with them.

Here is the federal definition:

• "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation"; or
  
• "An act or failure to act which presents an imminent risk of serious harm."

In most state definitions, harm can be also considered threats or intent to harm. Likewise failure to act can be considered intentional or unintentional (ie carelessness or negligence).

Just so you know as well, if you observe child abuse or neglect and fail to report it as a medical provider because you think it is a negative right, that is also a state/federal crime. https://www.childwelfare.gov/pubPDFs/report.pdf

Wait a minute, are we considering harm to be chemotherapy and radiation or no chemotherapy and radiation?

 

[SurfingDoctor]

Wait a minute, are we considering harm to be chemotherapy and radiation or no chemotherapy and radiation?

It wasn't directly related to either. It was in reference to the statement "They can put their own child at harm if they fully understand the pros and cons of their decision" which is a federal offense if parents willful action or inaction leads to harm to a child. For instance, a parent can't refuse to feed a baby just because they want to and its their kid. Likewise, a parent can't refuse to seek care for a child they know has a serious illness even if they don't know what the outcome of the illness will be.

In this case, intent to harm is harder to prove. Since the child underwent some medical therapies, but not the full recommended course, presence of the "Harm Principle", ie the actions of the parents are harming the child, is slightly harder to prove, because of just that, chemotherapy and radiation may have side effects and may not lead to a better outcome and therefore the parents are protecting the child. On the other hand, the child may have a good outcome after treatment with limited effects and the parents are harming the child. Not too long ago, the idea of children having rights was not an accepted notion (ie, child laborers which existed in the US in the early 20th century). After all, it was the parents child and they could do with them as they saw fit. As time has progressed though, the idea of parental autonomy over their children has been met with more an more legal action as people have recognized that despite not having the full capacity of understanding and consent, children have rights that parents can't refuse based on their own beliefs. That being said the "harm" in this case is grey, particularly at this case because their refusal after disease progression may not affect the outcome, but their refusal earlier on in the disease course may have. I suspect though that this won't be the last of this case. I don't know what the legal system is like in Australia, but I have seen a US District Attorney go after a perpetrator of child neglect that resulted in harm 20 years after the incident when the child/adult finally died.

I'm surprised there is not a Bioethics sub-forum here. This is a perfect example.

 

[3characterslong]

The article doesn't mention his prognosis or life expectancy without treatment, rather useful info to leave out.

What I don't get is why people are questioning the judgement of the parents. We have a layman's article here with few pertinent facts. To have the assumption the parents don't care or wouldn't do right by the child with their best judgement seems unwise.

FWIW: 3/3 pediatricians i've worked for think most parents are braindead *****s, so jumping to the conclusion that their judgement is poor is pretty par for the course.

 

[CaliforniaDreamer]

They can put their own child at harm if they fully understand the pros and cons of their decision as it's their child.

How could you not realize how wrong this was in the time it took you to type it...

 

[Donald Juan]

FWIW: 3/3 pediatricians i've worked for think most parents are braindead *****s, so jumping to the conclusion that their judgement is poor is pretty par for the course.

and FWIW, many doctors think 90% of their patients are braindead *****s (and most doctors I know think 90% of other doctors are also *****s). It doesn't give us the right to take autonomy away from patients so that we can save these idiots from themselves. And I think given the track record of what we as doctors off and on consider acceptable treatment or standard of care, I don't think we have any reason to think we're in a position to do so.

 

[Psai]

How could you not realize how wrong this was in the time it took you to type it...

? There are pros and cons to any course of action. Unless you think that chemo and radiation are benign

 

[Psai]

Well, I am just a lowly attending, but I understand the law regarding child welfare and what you just stated here "They can put their own child at harm if they fully understand the pros and cons of their decision" is the definition of child abuse/neglect. It is a federal crime in this country and illegal in many others. I have seen many parents willfully put their own children at risk and the courts and law did not side with them.

Here is the federal definition:

• "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation"; or
  
• "An act or failure to act which presents an imminent risk of serious harm."

In most state definitions, harm can be also considered threats or intent to harm. Likewise failure to act can be considered intentional or unintentional (ie carelessness or negligence).

Just so you know as well, if you observe child abuse or neglect and fail to report it as a medical provider because you think it is a negative right, that is also a state/federal crime. https://www.childwelfare.gov/pubPDFs/report.pdf

You mean like pumping a child full of toxic medication and doing incredible amounts of damage with ionizing radiation to vital organs? Yeah.

 

[vendtex]

You mean like pumping a child full of toxic medication and doing incredible amounts of damage with ionizing radiation to vital organs? Yeah.

Are you suggesting that you think parents should always have the right to refuse cancer treatments for their children?


Sent from my iPhone using Tapatalk

 

[CaliforniaDreamer]

? There are pros and cons to any course of action. Unless you think that chemo and radiation are benign

You said they can choose to harm their child just because it's their child and they "understand the pros and cons" (I'm not sure how you can legally gauge their level of understanding of the medical situation anyways), but that's specifically not usually the case as children have special legal protections that limit both their own autonomy/decision making and limit the decision making ability of the family. Of course this is a very tricky subject when it comes to edge cases, which is why it makes the news.

 

[vendtex]

I think it's reasonable to assume that the child is going to die soon without chemo. The general assumption is that when someone chooses naturopathy or other forms of alternative medicine, they are not looking out for their child's or their own best interests.

Not sure that's true in Australia. They seem to have a lot of anti-vax alt med types.


Sent from my iPhone using Tapatalk

 

[Psai]

Are you suggesting that you think parents should always have the right to refuse cancer treatments for their children?


Sent from my iPhone using Tapatalk

Should be decided on a case by case basis depending on the parents but as a general principle, yes. I can't imagine how I would feel if I was trying to let my terminally ill kid go but the doctors were forcing me to pump them full of chemo and radiation. Then to get a bill for it.

 

[SurfingDoctor]

You mean like pumping a child full of toxic medication and doing incredible amounts of damage with ionizing radiation to vital organs? Yeah.

First, you clearly missed the point since his parents decisions lead him to be terminally ill. They refused all chemotherapy and radiation and were court ordered to do at least chemo, which they didn't comply with (we won't get into the fact that you seem to suggest that treating children for cancer is a worse outcome than letting children die, I suppose that is your opinion and you are entitled to it).

Second, you can believe what you want. Fortunately there are safety nets in the legal system that protect children from harm. If one chooses to break the law by harming their children, one's opinion that they should do whatever they want to their children won't be a very solid defense. I have seen many people willfully harm their children. I'm glad the legal system ruled against the parents to protect the children (well what's left of them after their parents had harmed them irreversibly).

 

[Azete]

First, you clearly missed the point since his parents decisions lead him to be terminally ill. They refused all chemotherapy and radiation and were court ordered to do at least chemo, which they didn't comply with (we won't get into the fact that you think that treating children for cancer is a worse outcome than letting children die, I suppose that is your opinion and you are entitled to it).

Second, you can believe what you want. Fortunately there are safety nets in the legal system that protect children from harm. If one chooses to break the law by harming their children, one's opinion that they should do whatever they want to their children won't be a very solid defense. I have seen many people willfully harm their children. I'm glad the legal system ruled against the parents to protect the children (well what's left of them after their parents had harmed them irreversibly).

I certainly respect your viewpoint, but I think there's a big difference between willful harm and not wanting to intentionally inflict suffering on your child. People focus on the outcome that leads to a cure, but the alternative is the parents watching their child spend their last year/months in agony, then burying them anyway, followed by suicidal levels of debt forever.

 

[SurfingDoctor]

I certainly respect your viewpoint, but I think there's a big difference between willful harm and not wanting to intentionally inflict suffering on your child. People focus on the outcome that leads to a cure, but the alternative is the parents watching their child spend their last year/months in agony, then burying them anyway, followed by suicidal levels of debt forever.

Oh, I strongly believe in palliative care and wish at times more parents would choose that option when the alternatives are extreme without a likely benefit. Unfortunately in this case, the parents chose to forego treatment so that palliative care was the only outcome. In the legal sense, refusing life saving treatment for a child when the outcome could be good is child neglect and is an outcome that is certainly hard to defend.

 

[Stagg737]

Should be decided on a case by case basis depending on the parents but as a general principle, yes. I can't imagine how I would feel if I was trying to let my terminally ill kid go but the doctors were forcing me to pump them full of chemo and radiation. Then to get a bill for it.

And what if the parents are adamant that they don't want their child to receive chemo/radiation treatment but the child continuously expresses they want the treatment? Do you still side with the parents since the child can't give consent or are you going to side with the child's autonomy?

As for the "pumping their kids full of X treatment" argument, you're getting awfully close to sounding like an anti-vaxxer with that line of thinking.

 

[Donald Juan]

And what if the parents are adamant that they don't want their child to receive chemo/radiation treatment but the child continuously expresses they want the treatment? Do you still side with the parents since the child can't give consent or are you going to side with the child's autonomy?

As for the "pumping their kids full of X treatment" argument, you're getting awfully close to sounding like an anti-vaxxer with that line of thinking.

Comparing chemo-radiation therapy to vaccines? I don't know if you're just trying to win an argument, but you're way off the mark and I can't believe you got likes for that. That would be like saying, "refusing ECMO? You sound like a Jehovah's witness refusing a blood tranfusion!"

 

[SurfingDoctor]

Comparing chemo-radiation therapy to vaccines? I don't know if you're just trying to win an argument, but you're way off the mark and I can't believe you got likes for that. That would be like saying, "refusing ECMO? You sound like a Jehovah's witness refusing a blood tranfusion!"

No, I think the arguments are the same. The refusal of vaccines or chemotherapy has nothing to do with "child best interests". It has to do poor parental education or general distrust of medicine. They are projecting their own beliefs on their children and those projections have negative consequences. I took care of a series of children whose parents refused Vitamin K because babies back on the day didn't get Vitamin K and they survived so modern medicine is irrelevant. Unfortunately when their children had intracranial hemorrhage, it became obvious their beliefs were terribly misguided and ended up harming their children.

As for ECMO and blood transfusion, that it is much larger stretch. I've personally never seen a parent refuse ECMO for their child when the team recommended it. Have you? That being said, if it was clearly the only option with a likely good outcome, and the parents refused, I would get an emergency medical power of attorney. One's duty is to the child, not the parent.