ISD II – Pediatrics
Discussion Cases
1. Amber is a 15 year old
female who is requesting a prescription for the birth control pill. In conversation, you discover that she has
not yet had sexual intercourse with anyone, but is thinking about doing so with
her current boyfriend. She is not sure
that she will have sex with him, she says she just
wants to be prepared. Her boyfriend is
also 15 years old. They have been going out
for about a year and she says the relationship is “serious”. Amber does not want her parents to be told
about any of this.
What
factors are ethically/legally relevant here?
Should
you tell her parents about her request?
Should
you prescribe the birth control pills without telling her parents?
2. George is a 14 year old
male who visits his pediatrician regarding his
acne. George has a quite severe case and
has heard that there are drugs available that might help him deal with
this. In the pediatrician’s
opinion, the best treatment for his acne would involve taking Accutane. The drug
is well tested on children, but does have some minor potential side effects,
including nosebleeds, joint pain and headaches.
The pediatrician would be comfortable
prescribing the drug if George’s parents were part of this decision, but George
does not want them involved. They have
told him they disapprove of “taking drugs” to solve a “minor problem” like
acne. George, however, sees his acne as
a major problem and wants the prescription.
What
factors are ethically/legally relevant here?
Should
the pediatrician write the prescription?
3. Amber is a 15 year old female
who is requesting a prescription for the birth control pill. During discussion about this, she also
requests testing for HIV as she acknowledges she has had unprotected sexual
intercourse. (The HIV test returns
negative.) Amber does not want her
parents to be told about the HIV test nor about the birth control pills (if you
prescribe them).
What
factors are ethically/legally relevant here?
Should
you tell her parents about this visit?
Should
you prescribe the birth control pills without telling her parents?
Is
it your responsibility to inquire about the circumstances under which she is
having sexual intercourse (e.g., with an adult)?
4. Eleven-year-old Samantha
is a bright, loving child who was treated for osteosarcoma
in her left arm. The arm had to be
amputated, and Samantha was given a course of chemotherapy. She has been cancer-free for 18 months and is
doing well in school. She is
self-conscious about her prosthesis and sad because she had to give away her
cat, Snowy, to decrease her risk of infection.
Recent tests indicate that the cancer has recurred and metastasized to
her lungs. Her family is devastated by
this news but do not want to give up hope.
However, even with aggressive treatment Samantha’s chances for recovery
are less than 20%.
Samantha adamantly refuses
further treatment. On earlier occasions
she had acquiesced to treatment only to struggle more violently when it was
administered. She distrusts her health
care providers and is angry with them and her parents. She protests, “You already made me give up
Snowy and my arm. What more do you
want?” Her parents insist that treatment
must continue. At the request of her
physician, a psychologist and psychiatrist conduct a capacity assessment. They agree that Samantha is probably
incapable of making treatment decisions; her understanding of death is immature
and her anxiety level very high. Nursing
staff are reluctant to impose treatment; in the past Samantha’s struggling and
the need to restrain her upset them a great deal.” (From Bioethics for
Clinicians 9)
What
factors are ethically/legally relevant here?
What
should be done here?
Four years later, however, a spot is discovered on Jesse's other
kidney. Another tumour is suspected. It is decided that surgery will be
necessary to confirm the diagnosis. If, as his physicians suspect, it is
another Wilms tumour, the removal of Jesse's
remaining kidney will be necessary.
Jesse's condition and the need for an operation to confirm the
diagnosis are explained to him. He appears to understand the serious
implications of his illness.
Jesse agrees to go ahead with
the surgery to confirm the diagnosis, but is adamant that his other kidney
should not be removed: "I've seen those people on the machines" he says, "and I don't want to be like
that!" His doctor tells him he doesn't have to worry about that yet:
"At this point we just want to take a look to see what we're dealing with
here."
Jesse's parents sign the
consent form on his behalf. They inform the physician to do whatever he thinks
is necessary. During the subsequent surgery a Wilms
tumour is confirmed. Jesse's remaining kidney is removed.
How
should this situation be assessed ethically/legally?