Legal Involvement in Pediatric Cancer Treatment Refusal: A Qualitative Study.
| Autor: | Caruso Brown AE; Center for Bioethics and Humanities.; Division of Pediatric Hematology/Oncology, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York., Beskow LM; Center for Biomedical Ethics and Society., Benedetti DJ; Center for Biomedical Ethics and Society.; Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. |
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| Jazyk: | angličtina |
| Zdroj: | Pediatrics [Pediatrics] 2024 Nov 01; Vol. 154 (5). |
| DOI: | 10.1542/peds.2024-066180 |
| Abstrakt: | Objectives: To characterize the spectrum of legal options considered in cases of treatment refusal, nonadherence, and abandonment (TRNA); clinicians' thought processes regarding legal intervention; and perceived consequences of legal involvement. Methods: We conducted in-depth, semistructured interviews with 30 pediatric oncologists between May and September of 2019 regarding experiences with TRNA. The interview guide covered types of conflicts encountered; factors and strategies considered in response; effects of TRNA cases, personally and professionally; the role of ethical frameworks and legal requirements; and resources needed to manage TRNA cases. Interviews were transcribed and coded iteratively using thematic analysis. Results: Participants represented a range of institutional sizes, geographic locations, and years in practice. Twenty-five of 30 interviewees discussed legal consideration with regard to TRNA. Most participants first engaged the legal system through child protective service agencies. They considered patient age, treatment efficacy, quality of life (burden of treatment), and prognosis; family resources and social context; and preservation of therapeutic relationships and possible consequences of reporting. Experiences and outcomes of legal involvement varied. Conclusions: Clinicians struggle with the tension between obligations to report medical neglect and fears that reporting may result in more harm than benefit to the child in question. We urgently need more dialog between health care professionals and child protective services and legal professionals. Stakeholders from both groups would benefit from a greater understanding of the other's thought processes; clarity regarding the relevant facts; and mutual progress toward creative, evidence-based solutions to working out these complex challenges. (Copyright © 2024 by the American Academy of Pediatrics.) |
| Databáze: | MEDLINE |
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