A child has cancer. The family physicians recommend chemotherapy treatment as th

Question

A child has cancer. The family physicians recommend chemotherapy treatment as the only possible cure. The mother and father refuse the treatment and say they are going to take their child to a foreign country (like Mexico) for a type of treatment not authorized in the USA. The physicians notify the authorities of the family's decision, and the mother and father are charged with neglect of child and there is an attempt to remove the child from their custody. What is your view on all this? What is the legal vew verses a parents right to choose what treatment is best for their child?

Book: Legal Essentials of Health Care Administration

Explanation / Answer

Over the past decades, the established approach of physician directed decision making has decreased, whereas shared decision making, which includes the wishes of the patient and family, has increased. Although there is substantial literature dealing with declining or withdrawing treatment in adults with life-threatening illnesses, there is considerably less discussion of parents refusing or discontinuing therapy on behalf of their minor children with malignancies. Because cure rates for many childhood malignancies are more than 50% with standard therapy regimens, withholding treatment can be a difficult ethical dilemma for the treatment providers. The American Law assert that physicians are obliged to seek legal recourse when parental refusal places a child at clear and substantial risk. Many have assumed that a court will automatically order that the child be treated, but such an assumption may not be correct.

The law’s inquiry into parental competence to provide medical care for a child does not stop at assessing their physical and mental ability to do so; it also examines their willingness to make medically appropriate decisions. The decision of a physically and mentally competent parent to pursue a particular path of treatment may, for example, not accord with the best interests of the child, particularly if a child is not of an age where he or she can contribute to the process. Parents have a legal obligation to refrain from actions that may harm their child.

Legally if a treatment was more likely to succeed than fail (i.e., has greater than 50 percent chance of success), and the limited potential harm of the treatment, the state could be justified in gaining custody of a child to obtain medical treatment over the objections of his or her parents, although the court can have no definitive statement on this matter. Parents have more flexibility in choosing among different treatments that all have some scientific validity; they need not choose the best available treatment. The caveat here is what constitutes valid treatment—courts do not always agree on this. If alternatives may be successful and are less invasive than a risky standard medical treatment, courts may defer to parents. If the alternative treatment has no scientific merit, courts will most likely prevent parents from standing in the way of their child’s health.

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