A
12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He
asked the doctor about his prognosis. His parents requested the doctor not to
tell him the bad news. What should the doctor do in this situation?
Example
answer:
I
think this scenario raises numerous questions that are fundamental to the
practice of medicine, such as patient autonomy and the physician’s duty to tell
the truth. An additional facet of this scenario that the prudent physician must
consider is the autonomy of minors and the obligation to minimize emotional
harm to both the patient and family members. The ethical questions raised in
this scenario addresses whether or not physicians should disclose the truth to
minors where parents have requested that physicians not do so.
For
this specific scenario, I can definitely see both sides of the issue. On one
hand, not disclosing such information would prevent undue emotional harm to the
patient and family members. It would respect the parent’s wishes and intentions
to prevent harm to their children and “make the most of the time left” without
the burden of terminal illness and allow the parents the freedom to tell their
child when they feel appropriate. Furthermore, disclosure may involve the
breaking of a ‘trust’ between the parents and the physicians and may lead to a
mistrust of the medical profession itself. On the other hand, the primary
obligations of the physician are to the patients and not family members, and
the patient autonomy and wishes must be respected, even in the case of minors,
given that they can understand and appreciate the situation they are in. Ageist
attitudes that indicate that children are incapable of understanding major life
decisions have not been borne out in the research. Furthermore, physicians are
not free to employ deception in their practice, but should disclosure a
reasonable amount of helpful information that the patient wishes to know.
Given
the various interests of different parties in this specific scenario, the
physician would be wise to explore with the child what he understands about his
condition and what he expects out of this situation. The physician must assess
his level of capacity and maturity possessed to
determine if he is making an autonomous choice about knowing his condition. If
the patient is capable of understanding and appreciating the situation, the
physician should explore if the patient wishes to know the truth or if he would
like the physician to act in a limited paternalistic manner and do what is in
his best interest. I believe that physicians should disclose the truth that a
reasonable patient would want to hear in their situation, except in certain
circumstances, such as when the patient has waived the right to know. If the
child would like to know, care must be taken to disclose the information in a
hopeful and manner respectful to the child. Lastly, the physician should
attempt to explain his actions and his reasoning to the parents to minimize
friction between the family as well as the health care team, and provide
additional support to deal with the burden of a terminal illness. The physician
should also make careful notes of his reasoning and his actions in the
patient’s chart.
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