1. Ethics: The Dilemma Behind <18 year old Patient Rights to Information and Treatment
Kristin Schmitt, Susan Castillejos, Julie Mayo, Mayu Hoang, Shana Vazquez

2. The Scenario: + = Trust + = Dilemma The Rights/View of: Joshua?
His Parents?
How can the nurse support this family?
Joshua is dying.
Shhhhh
= Dilemma

3. Joshua’s view Veracity: telling the truth
Hawaii does not have a law supporting minor’s right to consent for general medical health services. For Joshua, knowing the truth can “foster trust, alleviate anxiety, increase pain tolerance, facilitate recovery and enhance cooperation with treatment” -Cherry & Jacob
Nonmalfeasance: duty not to inflict harm
In order to prevent harm, nurses need to prevent negative actions such as lying by omission, and preventing a child who is old enough to understand from being an active participant in his care.

4. Autonomy: allowing patient free choice
In Joshua’s case, he is not free to decide on types of treatments and he is not given the choice of what kinds of treatments he receives.
Beneficence: doing good to the patient
Doing good for the patient by providing pain relief, allowing to choice stop chemotherapy, allowing him to see friends, providing alternative therapy

5. Parent’s view
Factors influencing care or withdrawal of care may be due to religious reasons.
Feel that treatment will give them more time with the child.
Parents may decide to withhold information about diagnosis and treatment because they feel they are protecting the child or the child may not understand.
May not include the child in medical decisions because they think the child is too young to make decisions for themselves.
Laws are in place to provide parents with wide discretionary authority in raising their children (and deciding treatment). These laws are balanced with child abuse and neglect laws to ensure that a parent’s decision regarding treatment is in the best interest of the child.

6. But we’re his parents!!!
Parent may decide to spend “quality” time with child while he is alive.
Parents want child to continue to live a “normal” life and engage in “normal” activities.
Parents may have cultural beliefs that keep them from sharing bad news with the child.
Parent may feel it is their right to decide what information the child is told.

7. Resources:
Carteret, M. (2011, January 1). Cultural Aspects of Death and Dying. Retrieved March 19, 2015, from
Boonstra, H. & Nash, E. (2000). Minors and the right to consent to health care. Retrieved March 16, 2015, from
Cherry B. & Jacob A. Contemporary Nursing: Issues, Trends, & Management, 6th Edition. Mosby, VitalBook file.
Dicker, R. (2012, July 25). Parents Didn't Tell 12-Year-Old Adam Lewis He Was Dying -- Right Thing To Do? Retrieved March 19, 2015, from
Fortinash, Katherine M. & Holoday Worret, Patricia A. Psychiatric Mental Health Nursing, 5th Edition. Mosby Elsevier, 2012.
Haddad, A., & Vernarec, E. (2002). Adolescent has "had enough" with cancer therapy. Rn, 65(1),
Hord, J., Rehman, W., Hannon, P., Anderson-Shaw, L., & Schmidt, M. (2006). Do Parents Have The Right To Refuse Standard Treatment For Their Child With Favorable-Prognosis Cancer? Ethical And Legal Concerns. Journal of Clinical Oncology, 24(34).
Lally, R. (2007). Up front. The sounds of healing: unique pet and music therapy programs complement today's cancer treatments. ONS Connect, 22(2), 8-12.
Thomas, M., Menon, L. (2013). Consenting to pediatric critical care research: Understanding the perspective of the parents. Dynamics, 24(3),