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When a minor refuses treatment, what should a doctor do?
By Lauren | November 21, 2008
A few days ago, the Washington Post Express reported the story of a 13-year-old who wanted to refuse potentially life-saving surgery. The story focused on the question of whether a minor should be allowed to refuse treatment, but I found myself wondering about a different aspect of the story:
What about the ethical dilemma facing the doctor?
The medical profession has an extensive set of rules to help physicians wrestle with ethical conundrums. Those rules provide that a competent adult patient has the right to refuse treatment, and that the patient’s doctor has met the medical profession’s ethical standards so long as the doctor explains clearly to the patient what the consequences of refusal will probably be. It’s also pretty clear, both in the medical profession’s rules and under the law, that a minor is not normally considered competent to refuse treatment (although some courts are revising that norm for emancipated minors and some medical procedures). Ordinarily, a doctor who treated an unwilling minor would be well within the medical profession’s ethical rules, especially if one or both of the patient’s parents authorized the treatment.
Still, thirteen is not so young anymore, and it may not be reasonable to presume that a thirteen-year-old is incapable of making an informed decision to refuse medical treatment. This patient may not be an adult, but the patient’s wishes certainly deserve some respect. Should this thirteen-year old patient’s surgeon operate against the patient’s will, or should the surgeon support the patient’s decision not to have surgery, even if the consequences of that decision could be fatal?
The Post Express article suggested that the case is headed for court, and the judge will probably order the surgeon to proceed. With the support of the medical profession’s rules and a court order, the surgeon may be confident about going forward. At the same time, this situation demonstrates that even if the solutions to ethical dilemmas seem obvious, getting to them is not always a comfortable process.
Topics: Business Ethics, Professional Ethics, ethics |
November 26th, 2008 at 12:32 pm
Lauren,
I respect the fact that some thirteen year-olds are sufficiently mature minded and capable of both understanding the possible consequences of their decisions and making a wise, considered decision.
However, there has to be a point whereby a person is considered too young to speak for themselves from a medical viewpoint, and eighteen is an appropriate age for this in my view.
With no disrespect intended to minors, they should not have the legal right to refuse medical treatment, and surgical procedures should proceed or otherwise based on the professional opinion of the doctor as well as the (adequately informed) judgement of the parents of the minor concerned.
November 28th, 2008 at 3:50 am
To comment on Andrew’s comment…
You seem to have a very decisive view on what the legal rights of minors should be, but you didn’t really say why. I’d be interested to hear a followup, either from you or Lauren. (To the latter of you, sorry to turn this into any kind of debate if that’s not what you intended.)
November 29th, 2008 at 5:30 pm
I for one would like to hear the minor’s reason for wanting to turn down the surgery. It may inform the court’s decision. Perhaps they know something the doctors do not.
November 30th, 2008 at 5:39 am
Almost 17 years after Nick and Alice Zizzo adopted a brown-eyed, chubby-cheeked baby girl through San Diego County’s child welfare system, she came home one day bubbling that her high school choir was going to Europe. EARNIE GRAFTON /
December 1st, 2008 at 2:02 am
Hi folks,
Glad this post inspired some commentary - I think it’s a difficult issue, and it’s good to see that other people agree.
Andrew certainly has a point, especially if you’re the doctor facing this dilemma. If society declares that the 13-year-old can’t refuse the treatment, it makes it easy for the doctor to proceed. But I also agree with Mark that it makes a difference why the thirteen-year-old doesn’t want the treatment. If the “child” is, in fact, mature enough to make an informed decision, I’m a little troubled if society makes a blanket decision to ignore it. It’s important to protect minors, but it’s important to listen to them, too.
This situation demonstrates one of the truths of ethics - often, the toughest ethical dilemmas involve conflicting goods.
Lauren
December 1st, 2008 at 3:05 am
Lauren,
So now I am curious; why did the child refuse the treatement? Do you know?
December 2nd, 2008 at 4:45 am
Hi Jennifer,
The report didn’t say, but I wondered, too.
L.
December 12th, 2008 at 8:11 am
House”, starring British actor and two-time Golden Globe winner Hugh Laurie, follows the story of Dr. Gregory House (Laurie), an unorthodox physician. “Emancipation” is the name of the “House” episode that