“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
In the US, ages 18 and 21 are legal markers. Voting, drinking, serving in the military, buying a gun. A birthday changes rights, responsibilities, and obligations.
Medscape recently posted a case: A Teenage Girl Refuses More Cancer Treatment; Her Father Disagrees.
Here, the patient was a young woman, age 17.
She was diagnosed with osteosarcoma at age 9. She experienced half her life with a diagnosis of osteosarcoma.
The vignette stated, “she had received chemotherapy and had been under that treatment for a while.”
It was not clear if she had had prior surgery. But the story continued that initially her chemotherapy worked.
Given that this story was titled ethical conundrum, you can assume her cancer recurred. And it did.
She went to school and enjoyed sports. She was a real fan of softball and tried to manage the team and be involved. …she was planning to go to college. Her love of softball remained, but given the recurrence of the cancer, she had no chance to pursue her athletic interests, not only as a player, but also as a manager or even as a coach for younger players. That was all off the table.
Apparently, once her cancer recurred, standard treatments were off the table. The story did not provide details as to what type of recurrence was identified. Presumably systemic spread. No mention was made of surgery. And conventional chemotherapy was not an option; only an “experimental protocol.”
Again, unclear if “experimental protocol” meant a drug that was approved for different indications, or whether it was a novel medication in early clinical trials, and, if so, how far along was the drug in such trials. Phase 2? Phase 3?
Anyway, the 17-year-old drew a line in the sand. She said it was her body, her Choice. She had had enough.
She said to her family and the doctors that she didn’t want to do it. She would rather die. She couldn’t take any more chemotherapy and she certainly didn’t want to do it if it was experimental, with the outcomes of this intervention being uncertain.
Mom and Dad were not in line with their daughter.
Her dad said, “She can’t decide. She’s a minor. She’s only 17. I want you to do it — administer this novel form of chemotherapy and try to save her.” Her mother said, “Her input matters. I want to listen to her.” Her mom wasn’t as adamant about doing it or not, but she really felt that [the daughter] should be heard loudly because she felt she was mature enough or old enough, even though a minor, to really have a position about what it is to undergo chemotherapy.
An ethics consult was obtained. A social worker was brought in to discuss the case. The family had strong religious convictions, and their pastor was also brought in to discuss. The family discussed the case with all parties.
Here’s what the young girl wanted. Beyond no additional treatment.
What she wanted was to go to her prom. She wanted to get to her sister’s junior high school softball championship game.
Modest goals. But important goals to HER.
Ultimately, an agreement was reached that she would not undergo the experimental intervention. [All] agreed on a course of palliative care, recommended that as what the doctors follow, and they decided to do so. Sadly, [the daughter] died. She died at home. She did make it to her prom.
These are tough decisions. And each patient and each family are different. While this girl was technically a minor, she had lived with osteosarcoma for years. She would soon be age 18, if she lived that long. It seemed futile to provide chemotherapy, with its attendant side effects, which might allow her to live to age 18, only getting her to the point where she could legally withdraw further treatment.
If a judge has been forced to decide, it’s not clear how this would have gone. Ultimately, guardian ad litem would be assigned to look after the child’s interests. But given that the protocol was experimental with an uncertain outcome, a judge may very well have ruled for the daughter.
This is different than cases where a Jehovah’s Witness parent refuses to allow their minor child to receive a blood transfusion for an urgent procedure, one potentially associated with significant blood loss. There, the judge will almost always rule that the medical team CAN transfuse the patient.
Cases like these define why medicine in the real world can be difficult.
What do you think?
Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
Thanks goodness this was resolved with the family and some consultation and communication, and did not get brought into the legal realm.
One wonders if the new treatment had much if any chance of success.
But one also has to wonder about when a person has suffered enough because, let’s not kid ourselves, such cancer treatments are no picnic.
One has to be glad that the family came together and the outcome was, while not optimal, at least the best that could be obtained under the circumstances.
Jeff,
I, personally, would have consulted with Rabbi Segal, OBM.
Richard Willner
No parent ever wants his or her child to be sick and die. But the cost of ~enduring~ the treatment can only be borne by the patient. If a child of 3 has a Wilms’ tumor, the probability of curing him is close to 100%, so even if the kid doesn’t want to be treated, parental intervention is appropriate.
Let’s put the same Wilms’ tumor in a 17 year old who doesn’t ‘t want to be treated. Still most likely curable, but now there’s tension between parent and child/patient. Is it better to let the kid have his way and die or survive and hate his parents? Tough question, isn’t it? This is a situation of true equipoise.
But now look at the young lady with the osteosarcoma. VERY different prognosis from Wilms’ tumor: minuscule probability of surviving another year. And probably suffering for most of it, especially with treatment. So, lower quality of life and very likely non-survival vs. higher quality of life–doing what she wants with her (possibly) fewer remaining days. Seems to me that she’s the one with the currency [read: time] to spend as she wishes.
If it were my child, I’d do what she wanted and support those decisions. But I’d hurt and cry a lot, too.