Ethical Dilema
Case study
Nursing Ethics 19(4) 581–589 ª The Author(s) 2012 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733012448348 nej.sagepub.com
Pediatric consent: Case study analysis using a principles approach
Adaorah NU Azotam
Villanova University, USA
Abstract This article will explore pediatric consent through the analysis of a clinical case study using the principles of biomedical ethics approach. Application of the principles of autonomy, nonmaleficence, beneficence, and justice will be dissected in order to attempt to establish resolution of the ethical dilemma. The main conflict in this case study deals with whether the wishes of an adolescent for end-of-life care should be followed or should the desire of his parents outweigh this request. In terminal cancer, the hope of early palliative care and dignity in dying serve as priorities in therapy. Application of the moral principles to both sides of the dilemma aided in providing an objective resolution to uphold pediatric consent. Keywords Consent, case study, decision-making capacity, end of life, ethics, pediatric oncology
Introduction—case presentation
Max is a 17-year-old Caucasian male previously diagnosed with acute lymphocytic leukemia at age 7. In the past, he has endured multiple relapses of his cancer requiring chemotherapy every 2 weeks followed by periods of remission. This regimen was difficult for Max because of the nausea, vomiting, and pain associated with treatment. After remission for 3 years, Max was admitted to the pediatric intensive care unit (PICU) with complaints of bone pain causing inability to bear weight on his legs and increasing respiratory distress. At this time, it was discovered that he had osteosarcoma. Despite oxygen and continuous positive airway pressure (CPAP) support, aggressive chemotherapy, and localized high-dose radiation for 1 month, lung metastases and organ failure were found. The health care team scheduled a family meeting to
Nursing Ethics 19(4) 581–589 ª The Author(s) 2012 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733012448348 nej.sagepub.com
Pediatric consent: Case study analysis using a principles approach
Adaorah NU Azotam
Villanova University, USA
Abstract This article will explore pediatric consent through the analysis of a clinical case study using the principles of biomedical ethics approach. Application of the principles of autonomy, nonmaleficence, beneficence, and justice will be dissected in order to attempt to establish resolution of the ethical dilemma. The main conflict in this case study deals with whether the wishes of an adolescent for end-of-life care should be followed or should the desire of his parents outweigh this request. In terminal cancer, the hope of early palliative care and dignity in dying serve as priorities in therapy. Application of the moral principles to both sides of the dilemma aided in providing an objective resolution to uphold pediatric consent. Keywords Consent, case study, decision-making capacity, end of life, ethics, pediatric oncology
Introduction—case presentation
Max is a 17-year-old Caucasian male previously diagnosed with acute lymphocytic leukemia at age 7. In the past, he has endured multiple relapses of his cancer requiring chemotherapy every 2 weeks followed by periods of remission. This regimen was difficult for Max because of the nausea, vomiting, and pain associated with treatment. After remission for 3 years, Max was admitted to the pediatric intensive care unit (PICU) with complaints of bone pain causing inability to bear weight on his legs and increasing respiratory distress. At this time, it was discovered that he had osteosarcoma. Despite oxygen and continuous positive airway pressure (CPAP) support, aggressive chemotherapy, and localized high-dose radiation for 1 month, lung metastases and organ failure were found. The health care team scheduled a family meeting to
References: 1. Beauchamp TL and Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford University Press, 2009. 2. Whitney SN, Ethier AM, Fruge E, et al. Decision making in pediatric oncology: who should take the lead? The decisional priority in pediatric oncology model. J Clin Oncol 2006; 24(1): 160–165. 3. Unguru Y, Coppes MJ and Kamani N. Rethinking pediatric assent: from requirement to ideal. Pediatr Clin North Am 2008; 55: 211–222. 4. Zawistowski CA and Frader JE. Ethical problems in pediatric critical care: consent. Crit Care Med 2003; 31(Suppl. 5): S407–S410. 5. Spinetta JJ, Masera G, Jankovic M, et al. Valid informed consent and participative decision-making in children with cancer and their parents: a report of the SIOP working committee on psychosocial issues in pediatric oncology. Med Pediatr Oncol 2003; 40: 244–246. 6. Lee KJ, Havens PL, Sato TT, et al. Assent for treatment: clinician knowledge, attitudes, and practice. Pediatrics 2006; 118: 723–730. 7. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Research involving children: report and recommendations. Washington, DC: US Government Printing Office, 1977. 8. American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics 1995; 95(2): 314–317. 9. Oberle K and Hughes D. Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions. J Adv Nurs 2001; 33: 707–715. 10. Austin W, Kelecevic J, Goble E, et al. An overview of moral distress and the paediatric intensive care team. Nurs Ethics 2009; 16(1): 57–68. 585 Copyright of Nursing Ethics is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.