Discussion topic:
Alice is a 3rd year medical student at Boise Children's hospital. She is following the care of an 13-year old boy, Josh, who has recently been diagnosed with Ewing's sarcoma of his right proximal femur. The physician, Dr. Buttons, explains to Josh and his parents that the treatments have a very high cure rate and chemotherapy and radiation should be started immediately. Dr. Buttons explains to Josh's parents that Josh will most likely be infertile the rest of his life after treatment. Dr. Buttons recommends that Josh Bank his sperm quickly so that treatment may begin without delay. Josh's parent state that they are not interested in sperm banking and request that Dr. Buttons not tell Josh about the risk of infertility. At the private meeting with Dt. Buttons and Josh's parents, Josh's father state "Josh is too young to understand sperm banking."
Later that evening Josh is talking with his mother about his treatment and his future and says "I cannot wait to start a big family when I meet the right girl." Josh's mother relates this statement to Dr. Buttons and Alice. Dr. Buttons and Josh's mother also discuss some anger that Josh has towards his diagnosis.
Once Josh's mother leave the room Alice asks Dr. Buttons whether to inform Josh about potential infertility risks. Dr. Buttons states "Josh's parents know that Josh needs to be treated immediately and both parents have been very clear with me that they do not want Josh to know the risk of infertility. Alice, you and I must respect their wishes".
1) Alice wonders is Josh will suffer from this lack of information later in life. Do you think there was proper informed consent before Josh starts his treatment?
2) Do you think that the parents had all the information to make a good decision on their son's opportunity to sperm bank?
Discussion post:
From a moral ethical standpoint, I do not think proper informed consent was given in this case. A look at the Ethical Decision-Making Model confirms my position on the matter.^1 In step one of the model, the patient’s desires and quality of life are relevant questions to answer. The patient in this case has clearly communicated his desire to have children in the distant future, any impediment to his reproductive ability is likely to negatively affect his quality of life. Step three of the Ethical Decision-Making Model addresses where duty lies in the dilemma. In the utilitarian ethical theory, the greatest good to the greatest number of people must be considered. The physician in this case followed this model by serving the wishes of the patient’s parents. The moral dilemma this raises is that those who are not equally valued by society such as the adolescent in this case are at the mercy of the more valued opinions of the parents in this case. The ethical theory of deontology is arises from decision making based on rules. In this case the law is the ultimate judge of whether the physician’s decision to comply with the parent’s wishes is right or wrong. The issue of consent legality in matters of adolescent care addressed by Holder^2 indicates that the doctor in this case was within his rights to withhold information based on the parents’ wishes. Per Holder, physicians are required to properly inform minors and cannot withhold information. However, when parents want information to be withheld the physician can exercise professional judgement to comply with the parents’ wishes. In this case the moral ethical decision and the legal deontological model are not in agreement. The physician is under no legal obligation to comply with the wishes of the minor. However, by observing the Ethical-Decision Making Model we can address and answer questions concerning the patient’s wellbeing.^1 The ethical principal of benevolence states that staff should be willing to sacrifice their own time and effort to benefit the patient. In this case the physician could have sacrificed more of his time to better educated and explain things to the parents. If the doctor had taken this approach he may have been able to come up with a more benevolent solution.
References
1. Lenards N. Introductory Healthcare Ethics. [Softchalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2017.
2. Roddey H, From chattel to consenter: adolescents and informed consent. Yale J Biol Med. 2010 Mar; 83(1): 35–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844691/
Alice is a 3rd year medical student at Boise Children's hospital. She is following the care of an 13-year old boy, Josh, who has recently been diagnosed with Ewing's sarcoma of his right proximal femur. The physician, Dr. Buttons, explains to Josh and his parents that the treatments have a very high cure rate and chemotherapy and radiation should be started immediately. Dr. Buttons explains to Josh's parents that Josh will most likely be infertile the rest of his life after treatment. Dr. Buttons recommends that Josh Bank his sperm quickly so that treatment may begin without delay. Josh's parent state that they are not interested in sperm banking and request that Dr. Buttons not tell Josh about the risk of infertility. At the private meeting with Dt. Buttons and Josh's parents, Josh's father state "Josh is too young to understand sperm banking."
Later that evening Josh is talking with his mother about his treatment and his future and says "I cannot wait to start a big family when I meet the right girl." Josh's mother relates this statement to Dr. Buttons and Alice. Dr. Buttons and Josh's mother also discuss some anger that Josh has towards his diagnosis.
Once Josh's mother leave the room Alice asks Dr. Buttons whether to inform Josh about potential infertility risks. Dr. Buttons states "Josh's parents know that Josh needs to be treated immediately and both parents have been very clear with me that they do not want Josh to know the risk of infertility. Alice, you and I must respect their wishes".
1) Alice wonders is Josh will suffer from this lack of information later in life. Do you think there was proper informed consent before Josh starts his treatment?
2) Do you think that the parents had all the information to make a good decision on their son's opportunity to sperm bank?
Discussion post:
From a moral ethical standpoint, I do not think proper informed consent was given in this case. A look at the Ethical Decision-Making Model confirms my position on the matter.^1 In step one of the model, the patient’s desires and quality of life are relevant questions to answer. The patient in this case has clearly communicated his desire to have children in the distant future, any impediment to his reproductive ability is likely to negatively affect his quality of life. Step three of the Ethical Decision-Making Model addresses where duty lies in the dilemma. In the utilitarian ethical theory, the greatest good to the greatest number of people must be considered. The physician in this case followed this model by serving the wishes of the patient’s parents. The moral dilemma this raises is that those who are not equally valued by society such as the adolescent in this case are at the mercy of the more valued opinions of the parents in this case. The ethical theory of deontology is arises from decision making based on rules. In this case the law is the ultimate judge of whether the physician’s decision to comply with the parent’s wishes is right or wrong. The issue of consent legality in matters of adolescent care addressed by Holder^2 indicates that the doctor in this case was within his rights to withhold information based on the parents’ wishes. Per Holder, physicians are required to properly inform minors and cannot withhold information. However, when parents want information to be withheld the physician can exercise professional judgement to comply with the parents’ wishes. In this case the moral ethical decision and the legal deontological model are not in agreement. The physician is under no legal obligation to comply with the wishes of the minor. However, by observing the Ethical-Decision Making Model we can address and answer questions concerning the patient’s wellbeing.^1 The ethical principal of benevolence states that staff should be willing to sacrifice their own time and effort to benefit the patient. In this case the physician could have sacrificed more of his time to better educated and explain things to the parents. If the doctor had taken this approach he may have been able to come up with a more benevolent solution.
References
1. Lenards N. Introductory Healthcare Ethics. [Softchalk]. La Crosse, WI: UW-L Medical Dosimetry Program; 2017.
2. Roddey H, From chattel to consenter: adolescents and informed consent. Yale J Biol Med. 2010 Mar; 83(1): 35–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844691/