JerryM

Here's the link. I hope it can be opened. The article doesn't give much more information about the specific details of the case. But there's an interesting discussion by an ethics consultant.
<a href="http://www.ama-assn.org/sci-pubs/amnews/pick_02/prcb1007.htm" target="_blank">http://www.ama-assn.org/sci-pubs/amnews/pick_02/prcb1007.htm</a>

brighid

From the article: “ Because children do not develop at exactly the same rate, determining the precise degree of participation of each patient requires a great deal of expertise and communication between parent and physician so information can be provided in a developmentally appropriate way … This young lady definitely deserves the opportunity to know about her disease and her future, and the physician should do everything in his or her power to facilitate this … Facilitating this process requires careful communication with the parents. The first step should be to identify the father's motivations, feelings and needs.”

The jist of the article seems to be that the doctor should remain vigilant in his/her obligations to both parent and the pediatric patient, but to be aware of the extenuating circumstances that surround the father’s reluctance while providing individual and family counseling/support to help both through one of the most difficult circumstances any family can go through.


Brighid

Keith Russell

Greetings:

I have never understood why anyone would want to believe a lie, no matter how comforting.

One cannot respond (or react) genuinely, or effectively to untruth.

Keith.

brighid

Keith,

I agree, but I think in this case (or cases such as this) it is important to understand the emotional dynamics that come into play and as the article encourages work toward a resolute and ethical end to this dilema. In certain cases, denial (eventhough it is wrong) is a mental survival mechanism.

I would be very interested to see how this situation actually plays out, how the doctor handles this and how the father ultimately resolves this conflict.

I know tell my child that would probably be the most difficult and excrutiating thing I could possibly do. I know that I would tell him, by goodness knows I sincerely hope that as a parent I would NEVER have to confront this scenario.

Brighid

seanie

I've read the link and I can't say I'm terribly impressed. The answer given makes a fine statement about principles but doesn't appear to directly address the dilemma.

It doesn't actually say whether or not the child should be told against the father's wishes.

For example;

This young lady definitely deserves the opportunity to know about her disease and her future, and the physician should do everything in his or her power to facilitate this.

Does that mean they should tell her? If so why not come straight out and say it? What's with this mealy mouthed 'everything in their power to facillitate' bollocks.

I think they're evading the issue.

I agree with most of what's said (informing patients, trust, honesty etc.) And I'd certainly go along with involving counselling services to try and address the fears of the father and to persuade him that honesty is the better policy.

After all he might not be a moron. He's just found out his daughter's going to die. The poor bastard may be upset. Talking through the issue might help.

BUT

What if after all that the father still doesn't want his child to know?

What do you do then?

If you tell the child behind the father's back what will that do to the relationship between them?

If you openly go ahead against his wishes and tell the child what does that do to the relationship between the medical staff and the father?

If the father would rather remove the child from the hospital than have her told are you going to get an injunction?

I take it this kid doesn't have long to live. Would her interests be best served by an acrimonius court case?

These are all possible considerations.

I'd stick with my original reaction. I'd try to persuade him otherwise but when it really came down to it I'd go with the father's wishes.

It may be wrong but it's his decision.

Rusting Car Bumper

No. The parents usually die first.

DC

JerryM

[QUOTE]Originally posted by seanie:
[QB]I've read the link and I can't say I'm terribly impressed. The answer given makes a fine statement about principles but doesn't appear to directly address the dilemma.

For seanie:

You're quite right. Welcome to the real world of medical ethics. I have a particular interest here because I am a member of a hospital ethics committee (though we don't cover the pediatric hospital.) Usually, the advice we give when we consult on a case is more theoretical than practical. In this particular case, I would hope that the girl is receiving care at a facility with a childhood cancer service. Pediatric oncologists, and oncology nurses and social workers should have expertise in dealing with kids and families in these devastating circumstances. If anyone would be able to convince that father that it is in his daughter's best interests to be informed, they should. A good oncologist should be able to establish a rapor and explain things truthfully, yet still sensitively. However, if the father absolutely refuses, the medical staff can request that the child's care be tranferred to another provider. A parent has the legal right to make medical decisions for a minor, but a physician has no legal or ethical obligation to provide care which he or she believes, based on a good-faith medical jugdement, to be improper, unneccessary, or harmful. So if all else fails, there is a way out, though one hopes it never has to go that far.

Wyz_sub10

I don't think I can add much more to what's been said already. I would only say that the reasons for withholding this may be selfish or they may be considerate.

If my 11-year old was terrified of dying or if I knew she would take this to mean a punishment from god or something, I'm not sure I would rush to tell her.

On the other hand, depending on the time involved, she might want to do some very important things.

It's not a clear-cut issue, and I certainly wouldn't label the dad a "moron", even if he is in the wrong.

seanie

But narrowly speaking this isn't a question about medical treatment. The kid's going to die. We're into pain relief/palliative treatment here I assume. There is no suggestion that the father is seeking to obstruct such medical treatment.

He just doesn't want the child to know they're going to die.

That might present some difficulties for the staff treating the child but it's not obvious that it would interfere with the course of treatment itself or necessarily result in poorer quality medical care.

Someone posted that you can't respond genuinely to an untruth.

That's just bollocks.

Taking comfort from a falsehood may be misplaced, but it doesn't make the feeling of comfort any less genuine. I'm not sure telling the truth always is the best policy.

seanie

I've just remembered a horrific story.

A friend of my parents at University got married and had a kid. But they were driven up the wall by his parents. They kept coming round every day, never leaving them alone, always fussing and interfering. The wife in particular was driven up the wall.

And then, when the kid was 3 or 4, my parents friend died quite suddenly.

It subsequently turned out that when he was a minor he had been diagnosed with some untreatable terminal illness or somesuch. It was only a matter of time.

That's why his parent were always coming round. To see as much of him before he died.

But his parents never told him or his wife. They never got to spend 'quality' time together with the kid because they didn't know what was going to happen.

I don't know about the longterm but in the immediate aftermath the wife couldn't forgive her in-laws and wouldn't let them see the grand-child.

I think honesty would've been in order there.