Hi all I was wondering what the communities thoughts would be on the following 'ethical' dilemma You are the ward pharmacist for the Children’s Ward. As you walk through the ward, one of the patients, a 10-year old boy, calls out to you. He is alone at the time. He tells you that he is about to start a new chemo regime which his parents have told him will make him better, and asks you for some information about it. On checking his drug chart and notes you realise that this is in fact a palliative chemotherapy regime, which although it is likely to prolong his life by a few months is also likely to make him feel very poorly. What will you do? my take on this is the following: a) legally, not allowed to tell him squat really, because he's a minor, have to go via the parents, perhaps have a sit down with the parents if possible and explain to them but ethically... b) would you let even a young child have that false hope? under the assumption that they'll be 'happier' during their final days/weeks? discuss...
Pretty pointless hypothetical, but I doubt doctors would just go along with the parents lies and just play a big pretend-your-getting-better game. If hospitals can override parents wishes in court etc, I'm pretty sure they can tell you big nasty secrets that your parents don't want you to know.
from a legal perspective, when it comes to a minor, do the doctors/medical team have to ensure that the patient is fully informed or is it a case of let the parents decide?
I don't know, but like I said, a hospital can override parents wishes in certain situations, which is a lot bigger deal than telling the truth.
Hypothetically I would lie, if the kid was dieing then the pretence that he could get better would give him a happier few last months rather than worry about dieing. However in a real life situation I dont know what I would do, it would depend on the maturity of the kid.
+1, although not so much lie to the child, just not tell them. A good 90% of the time the parents know the child well enough to know what is best for him/her, so who are you/we to decide otherwise. If the child is going to die either way then why tell him/her that, why not just let them carry on with what is left of their short, to be prematurely ended, life. But, this is all a hypothetical, so I guess it doesn't matter and I sincerely hope it never will.
In most situations, the medical team fall under a duty to inform the patient about the course of treatment they propose and its risks and benefits; a patient who is not so informed has a cause of action against the doctors who failed to explain the risks that the patient has usually been adversely affected by. I'm unsure about whether or not that duty is extended to those who do not demonstrate competency to understand such information, but my gut feeling is that the duty is not extended to such people. It's not just children; the mentally infirm, or those with severe personality disorders can also be held to be 'incompetent' - it would be a waste of time asking for their ill-considered decisions - and instead have guardians appointed who are informed in their place and make decisions on their behalf. So, unless the child can demonstrate competency, there is no duty to inform. Competency is usually decided upon the facts of the case and the child in question. Since that's usually made in court, legally the child must demonstrate a given level of competence before being allowed to make decisions on their own behalf; it's to do with levels of understanding and not to do with being of a certain age. I forget the precedent, but it's been held since that children have the right to input into their parents' divorces, to medical treatment (remember the girl that refused a heart transplant?) and to other things that more typically the parents would decide. So, the child can be held competent following a legal challenge, and can therefore demand to be informed. If they haven't, there's no duty. Personally, in this case, I wouldn't inform them even if there was. What good can it do?
I would make sure the parents know and leave it up to them to decide if they feel it is best to not let the child know they are dying or not. If it was my own child I can see how I would not want them to know, but in some ways I wouldn't want to lie to them either. It would be quite a difficult decision that is for sure.
Based solely on the wording of your hypothetical situation, I would do nothing. This isn't my patient, so it would be presumptuous of me to approach either the child or the parents and interject my opinion on the matter. If the treatment is already scheduled, then it's probable that the child's regular physician has already discussed the matter with the parents. Besides, it's a person in a cancer ward. Chances are Nexxo has already been around and told the boy everything he needs to know.
I agree with Supermonkey. Remember you aren't Gregory House and things could go horribly wrong, losing your job now is surely not a good thing unless you happen to hold this higher than your own welfare.
Why thank you, because you are right. There is no ethical dilemma. Just call the Cancer Psychologist, damnit! First, Consultant Oncologists and Clinical Nurse Specialists (CNS's) nowadays get some pretty expert training (by a.o. the likes of yours truly) in the trials and tribulations of 'breaking bad news': telling the patient and family about severe and life-threatening diagnoses and treatment; helping the patient/family understand the diagnosis and treatment options; helping the patient/family make difficult treatment decisions and dealing with the emotional responses in the consultation. Besides that they are assisted by psychologically highly skilled CNS's and the Cancer Clinical Psychologist is no more than a phone call away (if the hospital has one, that is). So it is not as if such a situation can just develop in the first place. In situations where the competency of the patient is in question the cancer psychologist will get involved in the decision making around that. Where there is a tension between what the treatment team thinks the child should know and what the parents think the child should know, the Cancer Psychologist can organise a meeting with the team and parents (and in further meetings, the child) to discuss the parents' concerns and support them in supporting their child making valid and informed decisions about his/her treatment. Usually, when the parents don't want to tell their child the whole story it is because they don't know how to cope with the terrible truth and how to support their child in coping with it. Basically, helping them cope themselves empowers them in helping their child to cope. So, bixie_62, you can assume that your 10-year old will already have been explained all his options at least once in a sensitive and understandable manner. You can also assume that he has at least a year's experience (if not more) in being Really Seriously Ill and that makes a child grow up and grow wise quickly. Trust me, he may be in the picture more than you think. Being ill involves a lot of lying about not being able to do anything but think, and facing a serious life-threatening illness, he will have been doing a lot of thinking that raises all sorts of new questions. So if he asks you for some more information about the treatment he is about to have, you must consider the following possiblities: He is looking for more information. Not surprising, as there will have been a lot of information to take in and nobody can take it all in one go. This is well-known and it is not uncommon for doctors to meet with the patient a number of times to explain things. He is actually not looking for more information; he is looking for reassurance. That might be about his treatment (will it make me feel bad), his prognosis (will it work) or about other concerns (how will my parents cope, who will look after my pet hamster etc.). He is looking for comfort. He is lonely and bored and he wants someone to talk to. As such, when a patient asks you a question like that the first response needs to be: "What is it that you need to know? What other concerns do you have? Is there anything else on your mind?" before you dive in and try to answer the first question. You may not have the answers, and it may not be up to you to give the answers (because you don't know exactly what is going on and therefore you may not have good answers). But you can talk with him and elicit his questions and concerns and that in itself is of tremendous benefit to him in clarifying his own thoughts, worries, questions and needs, and who to ask for support in this. You can then pass all these questions, worries and concerns on to his team so that they can meet them appropriately.
