Other Ethical Dilemmas in Pediatric Oncology

Parents sometimes express the wish that their children not know the diagnosis or severity of their disease. At one time this sentiment would have received support in most segments of the pediatric oncology community, in which the culture of nondisclosure widely included the notion that children had to be protected from the psychological trauma of finding out about cancer and their chances of survival (Truog et al.). However, evidence indicates that children cope remarkably well with the shock of a diagnosis such as cancer and may adjust better psychologically to their disease and its treatment if they are informed early (Slavin et al.; Truog et al., p. 1412). Oncologists may legitimately use such findings to convince reluctant or fearful parents of the importance of disclosing to their children the nature of their disease.

The refusal by some parents to consent to any kind of medical intervention for their child poses another dilemma for oncologists. Cancer is typically a life-threatening illness, and oncologists subsequently display a relatively low level of tolerance for parents who deny them permission to treat a child diagnosed with the disease. Court orders usually are obtained to override such parental decisions. The situation can become more complicated, however, when a parent's decision not to treat a child biomedically is backed by a community whose values and life views differ dramatically from the mainstream, such as the ultraconservative segments of the Amish community in the Midwest. Careful negotiation aimed at building mutual trust and confidence may be required in such instances so that the best interest of the child and the community can be served.

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