The Ethics and Morality of Forced Treatment in Children

The Ethics and Morality of Forced Treatment in Children

The past decade has seen many instances of young cancer sufferers being forced by court order to undergo certain treatments. This has happened across the US, Australia and there have also been a few instances in the UK. On each occasion the stories have been met with a mixed response from the media and the general public with many believing that the decision to receive treatment should ultimately fall to the child/teenager and their parents, while others state that the decision to not receive treatment would be irresponsible.

The most recent case happened earlier this year in Western Australia (WA) when the courts ruled that Oshin Kiszko, a boy of just 6 six years old, was to receive chemotherapy against the will of his parents. Oshin suffers from medulloblastoma, a cancer of the brain that is treated with a combination of chemotherapy and radiotherapy. He has been made to suffer many intrusive surgeries throughout his short life and has now been unable to walk for as long as four months.

On hearing that the doctors wanted to start with chemotherapy and radiotherapy, which they suggest will give him a 50-60 percent chance of living for another five years, Oshin’s parents read as much as they possibly could about the effects and side-effects of the treatment. They found that the vast majority of the few that survive the treatment live out the rest of their lives with radiotherapy induced brain damage. This lead them to believe that such painful treatment, for five more years of poor quality life, was not worth it and so they rejected both the chemotherapy and radiotherapy. It was at this time that the courts intervened and made a state-first decision to force young Oshin to have chemo. They are to rule on whether he is to have radiotherapy early this week.

So is it moral and ethical to force children to have such treatments with the sole intention of keeping them alive, while severely diminishing their quality of life? This is a question that no one has the correct answer to at the time being. The law is vague on the matter and while it is something that should likely be discussed in parliament, so that legislation can be drawn up and a precedent set, there has been no move towards this as yet, meaning that each case is having to be dealt with individually.

This debate has many similarities with the debate surrounding euthanasia in that, because the final decision in each case ultimately decides the fate of one person’s life, no one that is in a position to change this from a grey area into a more black and white, law bound area, is willing to step up. This is most likely for fear of making the wrong decision, or simply the fact that no one knows what the correct decision is.

On one hand, it is true, that a child’s parents are likely to be the ones that know the child’s needs more than anyone else in the world. They have watched their kid go through the pains that they have undoubtedly suffered throughout the course of their illnesses, and they understand how the child themselves feels on a day-to-day basis. It is this knowledge that leads many to refuse treatment, deciding that their kid has suffered enough and they should be allowed to live out what’s left of their life in the most comfortable possible way, and this is entirely understandable.

On the other hand, parents do not have the medical knowledge and experience of the doctors and nurses who have provided the care to the child throughout the course of their illness. They clearly and unarguably know what is the best way to give the child the best chance at survival, and sometimes there are risks and side effect that come with that.

The problem lies in the fact that each case is entirely different. While in one case it may be necessary to provide a sick child with treatment, prolonging their life, while sacrificing some of their quality of life, another case may take away far to much of that quality to make it worthwhile. However not giving treatment, and instead letting a patient die, is not a choice that hospitals legally have. This is something that clearly needs to be addressed and this requires a politician to step up to the plate and make an issue of the subject.

It is clear to me that in some instances a parent’s judgement may be clouded by their lack of medical experience and their strong desire to stop their child from suffering any longer. In some instances sacrificing a small amount of quality of life for several more years is something that is clearly more than worth it. However it is also clear that no quality of life is something that should never be inflicted on someone just for the sake of more time on the planet. No grown adult would choose to be brain damaged and unable to speak for just five more years, so why are we insisting on inflicting this horror on children. They are not old enough to make their own decisions, that is true, but in that case we should look at what we would want if we were in their position.

One thing is for certain, this needs to be brought up and discussed in a political arena otherwise we risk alienating so many of the citizens that we are trying to protect.

Photo credit: Volkan_83 via / CC BY

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