An 8-year-old girl is admitted to the hospital for relapsed acute myeloid leukemia. Based on a recent bone marrow analysis, the patient requires aggressive treatment that includes multiple chemotherapeutic drugs and bone marrow transplant; chance of survival after 5 years is 20%. She is cared for by her mother, father, and maternal grandmother, who moved in with the family to help with her care. After extensive discussions among the family members and the physician about treatment options and prognosis, the girl states that she does not want to be treated. She is behind in school; she says that the treatments make her feel terrible, and she wants to go home to have more time with her friends. The patient's parents appear to understand their daughter's concerns but want treatment started immediately. On examination, the patient is alert and interacting appropriately with no remarkable findings except for generalized pallor. Which of the following is the best next step in management of this patient?

Question

An 8-year-old girl is admitted to the hospital for relapsed acute myeloid leukemia.  Based on a recent bone marrow analysis, the patient requires aggressive treatment that includes multiple chemotherapeutic drugs and bone marrow transplant; chance of survival after 5 years is 20%.  She is cared for by her mother, father, and maternal grandmother, who moved in with the family to help with her care.  After extensive discussions among the family members and the physician about treatment options and prognosis, the girl states that she does not want to be treated.  She is behind in school; she says that the treatments make her feel terrible, and she wants to go home to have more time with her friends.  The patient's parents appear to understand their daughter's concerns but want treatment started immediately.  On examination, the patient is alert and interacting appropriately with no remarkable findings except for generalized pallor.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d74b_8478_bc81_3bf6f4c7a7c7_MD0003_00 Informed consent is required for all medical care except for immediate, lifesaving interventions (eg, emergency intubation). Minors (age <18) have medical decision-making power only in certain medical situations that allow for confidentiality (eg, contraceptive care) and in legal scenarios that grant emancipation (eg, married, active military). In all other circumstances, including this case, a parent or guardian is responsible for providing consent. Assent, defined as agreement with treatment, is ideally obtained from a minor but is not required to proceed with treatment. By around age 7, children typically can make logical decisions, and minors' involvement in their medical care should match their level of developmental maturity, with an increasing role during adolescence. If a child refuses to assent, an open discussion is advised to emphasize the importance of pursuing the treatment plan decided on by the parent or guardian. As a minor, this patient's decision-making capacity does not affect the treatment plan because her parents are responsible for medical decision-making (Choices A and B). (Choices D and E) Requesting additional input from extended family members or from an ethics committee is not necessary because the parents have already agreed to treatment. An ethics committee is particularly useful when parents do not consent to treatment that may be in the best interest of their child. Educational objective: Parental consent is required prior to providing nonemergency medical care for a minor who does not qualify for confidential care (eg, pregnant) or is not emancipated (eg, married). Assent from the child is ideal but not required to proceed with treatment. References: Informed consent in decision-making in pediatric practice. (http://www.ncbi.nlm.nih.gov/pubmed/27456514)

An 8-Year-Old Girl Is Admitted to the Hospital for Relapsed