Introduction
There are conditions in which medical treatment is provided either forcefully or without informed consent. There are plenty of such incidents arising with patients suffering from personality disorders, dementia and even with cancer treatment for non-consenting minors. There are some fundamental questions that arise regarding the existing law. A minor, who has little understanding and intelligence about the cancer treatment, cannot comprehend fully as to what is involved in their treatment. Anyone aged 16-17 is supposed to be deciding the consent for their treatment.
There was a case of a child patient who was severely mentally and physically disabled child, and because of a post-operative complications, he was put on a ventilator. There were discussions between doctors and family members regarding further intensive care. When he was readmitted, his mother was spoken to about the use of morphine to alleviate distress and pain. The mother was opposed to this but was told that this was in the best interests of her son. When the child was readmitted again, he was given the diamorphine infusion. The family rebelled saying that the patient was secretly being euthanized and took the matter to the court. The Court cannot be held accountable for errors of doctors and nor can it regulate medical practice. Still, there is a need to place legal safeguards that ensure that the decisions and practices are of high professional standards, and work in the best interest of minor patients (Gevers 2004 p. 225)
Thesis Statement A child who is under the age of 16 doesn’t carry the right to refuse or agree to the treatment, and the consent is given on their behalf by a parent. In those cases where a young person refuses to consent, the court can overrule their decision.
Thesis: It is wrong for the court to mandate cancer treatment for non-consenting minors.
It is essential to look into the subject as children have run away from home as they did not want to undergo those harsh chemotherapy treatments. The court ordered these children to return home and try out nature medicine or a medical treatment.Normative Perspective The normal perspective is that it is not right to force someone to put medicine into their body that they intensely refuse to take. Traditionally, minors have always been looked upon as dependents of their parents and thus, do not carry any legal rights until they reach the age of majority. It shows that legally, they are dependent on their parents to offer or refuse consent to any medical procedures. However, during the past century, the courts have provided for exceptions to this rule and the minor is given the responsibilities of an adult. The United States Supreme Court has further extended the fundamental right of privacy and bodily integrity for the minors (Hanisco 2000p. 899-959). The traditional dependency doctrine creates a paradox as it denies the mature minors the right to make responsible decisions, but grants the immature minors the legal ability to make medical decisions.
It is the responsibility of the medical health professionals to not to keep their patient in the dark and encourage judicial intervention. They cannot force children or their parents to undergo certain medical procedures. There are any cases happening across the globe that have sparked an intense legal and ethical debate. Experts have questioned if doctors and lawyers should be able to allow to override the wishes of patients or their children in providing certain medical care.
Children may disagree with their parents over health care decisions. In some cases, the parents may refuse treatment for their child based on their religion (Chen 2007 p. 643) or where there are very slim chances of success rate. The courts might not agree with the parents' decision to refuse treatment solely based on religious beliefs.
Application of Normative Perspective to the Question Minors hate Chemotherapy, as it makes them really sick; their stomach hurts for lots of days and worse, their hair fall out. They simply cannot stand the painful side effects. Moreover, Chemotherapy is known to kill even the healthier cells in the body, along with the cancerous cells. The patients have to deal with the side effects of the therapy for many years. Many doctors often do not warn their young patients about all those side effects before starting treatment. One should make no mistakes here that chemotherapy can be rough and horrible, especially for the children. There are natural, plant-based, treatments that have effectively cured certain cancers. Parents should seek information on those and look for another form of therapies rather than forcing certain medical care on their child.
Radiation and chemotherapy are the two standard treatments for cancer and act by destroying the cancerous cells. As the therapies also end up destroying healthy cells, the patients have to deal with severe effects and adverse reactions. Children are especially sensitive to these therapies and thus should not be forced to undergo chemotherapy. Moreover, the physicians can never be 100% sure as to how a child's body will react. Therefore, the children who undergo chemotherapy are very closely monitored. Generally, the doctors weigh the severity of side effects against the advantages of treatments when giving the treatment.
The recent years have seen the struggle between parents and medical teams treating ill children on the rise. The children as patients and individuals do need their respect for autonomy, justice, beneficence, and non-maleficence. Children are treated as they were not autonomous, and the adults make the decisions for them. It is common to see the decisions made by children overruled by adults (Baines 2008 p 141-5). The question arises if autonomy can be applied to the children, who are not autonomous yet. In that respect, one has to look into if autonomy is appropriate in children. One cannot expect children to become responsible for their own decisions overnight.
The parents' authority too needs to be questioned if it is not imposing nay harm on the child. After all, there is no basis of the parental authority, and it is just taken in stride. The parental authority must work in favor of the child's interests. There is no justification for the parent's authority if it is harming their child in any way.
Many a times, parents may not allow a child needing major surgery as it may cause them pain or lead to disfigurement. It is perhaps the parent's inability to accept their child's illness. Sometimes, the parents demand a painful treatment to continue long after because of their strong desire and hope to see their child recover. The love and dedication that parents feel towards their child, can come in their way of making a sound decision, especially, when it relates to a critical illness like a cancer (Baines 2008 p 141-5). It is their very commitment to their child that prevents them from making an impartial assessment.
According to United Kingdom voluntary regulation, in case of a disagreement between the representatives of an incompetent patient and the health professionals, the responsible care providers should intervene and seek a court authorization to carry out their decision. The involvement of a third party has its pros and cons (Gevers 2004 p. 225). Often the medical situations involving such conflicts are complicated, and the court or a similar body is not seen as the right authority to judge the best possible course of action on medical grounds. Secondly, it would be tough for the court to make a doctor go back on his clinical judgment.
Answering Objections Chemotherapy has rid the cancer from patients and placed them in remission. It is often forgotten is that the therapy can also be life-saving for the child. However, it has been argued that the cancer can return. Conflict between physicians and families not only lead to courts, but also destroy the physician-patient relationship. Physicians need to assess the decision-making capacity of their patients and offer them the best advice and information regarding the treatment. Young children undergoing chemotherapy, dread the treatment and run away from home, seeing that neither his family nor the physicians are supporting his decision of discontinuing the treatment (Traugott et al. 1997 p. 922-7). They feel that the therapy is killing them of helping them out.
Proponents of chemotherapy say that the chemotherapy does not slower brain cognitive functions or lead to memory loss. Well, this is because not enough research has been done in the field, and one is still unsure of the long-term effects of the therapy on the children. Research has shown that the brain undergoes some kind of changes because of cancer drugs. Moreover, doctors admit that radiation treatment can lead to thinking and memory problems. Recently, chemotherapy has been associated with similar kinds of problems (Meyers 2008 p.11). Although little is known about the underlying mechanism, but chemotherapy is known to affect cognitive function, according to a new study.
Children under such scenario are very reluctant to continue with the therapy and look out for alternative therapies. These children when forced to undergo chemotherapy are kept in isolation and allowed limited parents visits. A security guard may be placed outside their door until they promise cooperation with medical staff. They do not want to undergo the "torture" of chemotherapy. Moreover, the complete effects of certain new chemotherapy regimens are still to be realized.
It has been argued in the courts and among the medical authorities that a minor does not know what is best for them. Well, in most cases, the children have been no younger than 11. Parents are considered to be the appropriate decision-makers, but their power of decision-making may be overruled to preserve the best interests of the child. It becomes complicated to handle the balance between parental authority and the interests of the child. Parental authority can be overruled if the court feel that the minor would die without medical intervention (Traugott et al. 1997 p. 922-7). The courts however have allowed parents to reuse the invasive treatments like chemotherapy for cancer because of severe and long-term adverse effects.
As children grow older, they develop the capability to make decisions about their health care and treatments. However, both law and ethics allow certain younger minors too to make their own decision. Once they have understood the pros and cons of the treatment and what other alternative treatments are available, they may be in a better position to make decision. However, when the younger adolescent patients aged 16 or 17 refuse chemotherapy, the physicians need to study their decision-making power which is the right procedure to follow (Traugott et al. 1997 p. 922-7).
The parents and the children should have the right to decide when to stop and try natural medicine instead. After all, there is nothing wrong in going for alternative medicine, and plus the option of going back to chemotherapy is always there. Furthermore, it is not right that strangers should decide what treatment is best for the family and their child.
Many feel that delaying chemotherapy and trying out alternative natural medicine can hasten complications. Well, sound ethical practice are needed in place to respect the dignity of the patient. There is a need to address the individual values and concerns of the adolescent patient (Traugott et al. 1997 p. 922-7). It is important to understand here if the patient and his family understand the pros and cons of the decision, the risks and benefits, etc. The doctors always warn the patients of the consequences of stopping chemotherapy.
Moreover, chemotherapy is not guaranteed to work, and it can damage lungs, cause infertility, heart problems. There are some cancer types, such as Hodgkins Lymphoma, where the chemotherapy can go months or even a year. Doctors are not sure how long a patient can wait, or this is why they recommend chemo right away. Chemotherapy can keep them down physically and emotionally. It can be tough coping with a diagnosis of cancer. The child will feel great discomfort, not be able to sleep, or eat properly, etc. There can be a drop in his red cell counts and make him anemic (MacDonald 2009 p.665-8).
There is a lot that needs to be researched about cancer treatments, as some new treatments are still being discovered or tested; it is wrong to rule out natural cures at this point. It is more important to achieve the right balance between parents and minors as there is a risk on both sides. Simply asking for parental consent without an input from the minor can lead to unwelcome situations. Most parents withhold complete information from their child about their illness in order to avoid difficult conversations and to disturb the child. However, this can spoil their relationship and can be detrimental as this behavior can will only heighten the sense of alienation. It is true that the younger adolescent is between childhood and adulthood. He is hovering between childhood dependence and adult independence (Chen 2007 p. 643).
Nevertheless, he has every right to enjoy the autonomy in his decisions and know what the treatment is for and what exactly should he expect. Many young adolescents demonstrate a fair amount of maturity and exhibit the requisite level of maturity.
Conclusion
In the case of any absence of legally competent patient for his consent or refusal for the treatment, it is considered lawful to presume consent to treatment in case of an emergency. The law states that it is essential to save the life of a person. Keeping these aspects in mind, it is unlikely that a minor may not be able to refuse treatment, in case there are likelihoods of serious consequences. When parental consent is no available, the medical authorities take a decision that is in the patient's best interests (Bennett 2000 p. 40-2). Parental consent to treatment and refusal of treatment may be overridden in the case of minors.
It is essential for the doctors to offer patients an option of how they want to treat their cancer. They should have an open and candid conversation with patients of all the pros and cons of every possible treatment (natural or not). Regardless of whether a patient is a minor, if they opt for alternative medicine, they should be allowed to do as they please.
The Court is of the opinion that the children's interests are best protected when they are represented by their parents. In many ways, the courts have failed to examine interest of minors and have felt that by defending the parents' interests, it was protecting the minor's interests. It is presumed that the child lacks maturity, and only his parents can decide what is best for him. However, a conflict may arise with slightly elder minors (Chen 2007 p. 643), the medical authorities and the parents, regarding the choice of therapy to be undertaken. Courts hold that an adult and competent individual has the right to refuse life-sustaining medical treatment.
Generally speaking, the parents and caretakers are the ones who offer consent to health care for a minor or younger adult aged 16 and 17. However, there are a number of situations, where the law allows the minors the same autonomy as adults, for instance, in case of decisions related to pregnancy and abortion decisions, STDs and drug dependency, etc (Chen 2007 p. 643). Teens can make their own decisions related to abortion without needing parental consent.
This regard to parental authority over their children is driven by two beliefs that, the parents possess the maturity and capacity to make the difficult decisions for their child. Next, the natural bonds of affection will make the parents work in the interests of their child. Thus, the parents are never doubted as decision-makers for their children. Despite the broadly held belief that parents will always act in their child's benefit; the parental authority is not looked upon as to be absolute. This is based on the belief that the child too carries a sound mind in a sound body, especially when he is growing up (Hanisco 2000 p. 899-959). The state does not refrain from intervening in the parent-child relationship and exercises its authority where needed. The role of the court is necessary especially when child is suffering from a life-threatening illness or injury.
It is evident that both parents and the state have genuine interests in the welfare of children, but there is a need to draw clear guidelines for children, and what importance does their view hold. In reality, there has been little expansion of legal rights of the minors, and more efforts need to be done in this direction, especially in the medical arena.
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Traugott, Isabel, and Ann Alpers. "In their Own Hands: Adolescents' Refusals of Medical Treatment." Archives of Pediatrics & Adolescent Medicine 151.9 (1997): 922-7.
