Reactions of Pediatricians to Refusals of Medical Treatment for Minors

Respecting Adolescents’ Autonomy (as Long as They Make the Right Choice)

“…In this issue of the Journal of Adolescent Health, Talati et al present a fascinating look at professional views on adolescent autonomy using the ethical dilemma of refusal of treatment [12]. Their paper presents findings from a study in which 421 American pediatricians completed a survey about their reactions to hypothetical scenarios in which treatment was refused for a minor suffering from cancer.…”

“…In other words, as young people grow older, and as the importance of treatment decreases, pediatricians become more likely to accept a refusal of treatment [12]. When parents and adolescents concur in their decision about treatment, pediatricians are also more likely to accept a refusal.…”

Assessing an Adolescent's Capacity for Autonomous Decision-Making in Clinical Care

“…It requires from the provider to also be aware of the potential biases that are linked with his or her own prejudices that may interfere with the ability to provide a neutral assessment of the adolescent's decision-making capacity. This bias may arise for example from the provider's own judgment of what can be considered as competence and the final outcome of the decision process; a recent research has showed how different pediatricians react to a potential refusal of treatment, depending on the perceived prognosis of the condition [33]. In most parts of the world, the deliberation within a team is probably the best way to address this difficulty and to assist practitioners in making a fair decision.…”

Teen Health Care Decisions: How Maturity and Social Policy Affect Four Hard Cases

“…And, again mirroring medical practice with adult patients, doctors are less likely to honor a child's refusal, the younger the patient is and the more promising the treatment. They are least likely to accept refusals when a minor with a life-threatening condition refuses a favorable treatment (Talati et al, 2010;Mosoff, 2012;MacIntosh, 2016). Similarly, courts rarely find the mature minor rule applicable when the child has already suffered injury or died for lack of treatment (Commonwealth v. Cottam, 1992;Commonwealth v. Nixon, 2000).…”

“…On the other hand, doctors are more likely to honor a refusal when the parent and child agree. When the treatment's efficacy and side effects are more ambiguous, doctors tend to honor the views of older children, regardless of whether they accept or decline treatment, provided that the consequences are not too severe (Talati et al, 2010). The next section discusses how the traditional principles would probably apply in the four hard cases that this chapter addresses.…”