Decision-making through the lens of a pediatric cancer case

Abstract

It is crucial to obtain a competent individual’s informed consent in any medical process, including cancer treatments. However, when it comes to incompetent children, it seems to be favourable, but not necessary, to obtain their assent in medical practice.1 This paper considers Christine Harrison’s example of Samantha, an eleven-year-old girl that was treated for osteosarcoma in her left arm. Samantha had previously been treated by amputation and a course of chemotherapy. This cancer later metastasized to her lungs, decreasing her chances of remission with aggressive treatment to 20%. Although she wanted to refuse treatment, she was deemed incompetent to make decisions about her cancer care, and her parents adamantly wanted her to continue treatment.7 This paper considers physicians’ moral obligations in pediatric cancer cases such as Samantha’s. I will define assent, the principles of autonomy, beneficence, and competence as it pertains to children. I consider arguments of two opposing views–a child’s rights view that argues in favour of Samantha’s decision, and a paternalistic view that opposes her. After reviewing the bioethical literature on the risks and benefits of children’s decision making in health care, I argue that Samantha’s wishes to stop treatment ought to be respected.Throughout the paper, I will use the bioethical principles of respect for autonomy and beneficence to defend my position. Finally, I address potential objections my position may face and conclude.