Ethical Issues Raised by the Media Portrayal of Adolescent Transplant Refusals.

Abstract:

:Cases of adolescents in organ failure who refuse solid organ transplant are not common, but several have been discussed in the media in the United States and the United Kingdom. Using the framework developed by Buchanan and Brock for surrogate decision-making, I examine what role the adolescent should morally play when deciding about therapy for life-threatening conditions. I argue that the greater the efficacy of treatment, the less voice the adolescent (and the parent) should have. I then consider how refusals of highly effective transplant cases are similar to and different from refusals of other lifesaving therapies (eg, chemotherapy for leukemia), which is more commonly discussed in the media and medical literature. I examine whether organ scarcity and the need for lifelong immunosuppression justify differences in whether the state intervenes when an adolescent and his or her parents refuse a transplant. I argue that the state, as parens patriae, has an obligation to provide the social supports needed for a successful transplant and follow-up treatment plan, although family refusals may be permissible when the transplant is experimental or of low efficacy because of comorbidities or other factors. I conclude by discussing the need to limit media coverage of pediatric treatment refusals.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Ross LF

doi

10.1542/peds.2020-0818H

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

S33-S41

issue

Suppl 1

eissn

0031-4005

issn

1098-4275

pii

peds.2020-0818H

journal_volume

146

pub_type

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