How to handle pediatric communication; phone policies

Ethics Forum. Oct. 7, 2002.

Scenario: How much should child patients be told?

Presenting with lethargy and flu-like symptoms, an otherwise healthy 11-year-old girl is admitted to a hospital for diagnostic tests. She is diagnosed with an advanced and aggressive form of cancer for which there is no effective treatment and given a poor prognosis. Her father requests that his daughter not be informed of the diagnosis or prognosis. How should a doctor approach this? Can a competent and intelligent minor become the patient in the patient-physician relationship?

Reply:

Identifying and facilitating the patient's best interests is the model for medical decision-making. In adult ethics, autonomy is the predominant principle that guides this process. Informed, competent patients acting without coercion are assumed to be in the best position to make decisions about their own health care.

Pediatric ethics, on the other hand, is largely ruled by the principle of beneficence due in large part to limitations in the patient's ability to act autonomously. For infants and young children, the parents and physician work together in a shared decision-making process. With the education and guidance of the physician regarding the complexities of the child's illness, the parents are generally regarded to be in the best position to determine the child's best interest. But as children navigate the passage from childhood to adolescence to adulthood, they take on a progressively more active role in the decision-making process. Parents, physicians and pediatric patients share a unique relationship in this process. [...]