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Public split on the use of 'second-best' medical treatments in children
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Although clinical practice typically implements best practices, the general public is divided on whether parents should be allowed to suggest less effective treatments for their children, even if that treatment increases the risk of disability or death.
“There has been research into the ethics of parental refusal of treatment, for example, Jehovah’s Witness parents who refuse a blood transfusion for their children,” Dominick Wilkinson, PhD, faculty of philosophy from the Oxford Uehiro Centre for Practical Ethics at the University of Oxford, and colleagues wrote. “In cases where the life of the child is at risk, it is widely accepted that doctors should override parents’ wishes. But the question of what doctors should do when parents are not refusing treatment, rather requesting a substitute ‘second-best’ treatment, has attracted less attention.”
To assess at what point parental choice of a less effective treatment can be used, the researchers conducted an empirical analysis and an ethical analysis in which an online survey was used to collect the general public’s threshold for acceptable harm and expense created by these choices, as well as the role religion played in these responses. Additionally, Wilkinson and colleagues found and employed existing ethical frameworks to examine the case presented in the survey to compare the theoretical and empirical results.
Of the 242 people who took the survey, 73.6% provided valid responses. As risk or cost increased or the patient, respondents were less likely to agree to the less effective treatment suggested by the parent (P < .001). Over half of the respondents agreed to provide treatment that had an absolute increased risk of death if the increase was less than 5% and if the cost increase was under $500 (United States currency). Respondents were more likely to entertain requests if they were made from a religious stance (P < .001).
When existing ethical frameworks were used on the provided case, results were ambiguous. The researchers observed obvious inconsistencies between the theoretical and empirical results from the survey.
“Although some differences were statistically significant, respondents’ opinions in our survey were divided between agreement and disagreement for all questions,” Wilkinson and colleagues wrote. “Even for the most serious of risks — disability and a large increased risk of death — a relatively large proportion of the cohort supported parents’ request, showing a striking willingness to allow parents to make decisions that risked harm to their children … This is notably different from norms in clinical practice.” – by Katherine Bortz
Disclosure: The authors report no financial disclosures.
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