Case of the Quarter
Case of the Quarter is a quarterly event where participants analyze and submit responses to a clinical ethics case. There is also an opportunity to win exciting giveaways for those who take part.
Tara is a 16-year-old girl with leukemia. After an extended period of treatment, the curative interventions are no longer effective in stopping or slowing down the disease progression. The clinical team has determined that Tara should be transitioned to comfort care to manage her symptoms and provide palliative support.
Tara has a very close relationship with her parents, who have been deeply involved in her care. This week, Tara’s oncologist, Dr. Sloan, informed her parents that the treatment is no longer working as hoped and all curative options have been exhausted. Moving forward, Dr. Sloan recommends comfort care to reduce pain and symptoms. Tara is psychologically very mature and has, in the past, been involved in making decisions related to her health. On previous occasions, she has shown that she can understand information about her disease and the interventions.
Although Tara has been involved in making decisions related to her health care in the past, on this occasion, her parents have made it clear that they do not want Tara to be told that the curative interventions have failed and that a comfort care approach is now being planned. They believe that disclosing this news to Tara would be harmful because it will cause her to develop fear and lose hope, which will, in turn, negatively affect her health.
Dr. Sloan recognizes that Tara shares a close relationship with her parents. She worries that disclosing this information to Tara, against her parents’ wishes, may jeopardize the clinical team’s relationship with the parents. However, given Tara’s maturity and past involvement in her health care decision-making, Dr. Sloan feels uncomfortable at the thought of not telling Tara the reality of her condition and her prognosis. Furthermore, Dr. Sloan believes that by not disclosing this important information to Tara, she may have false hope and be denied the possibility to prepare for her imminent death. Alternatively, Tara may already know she is dying and be living with that knowledge in isolation.
Question
What is your next step?
- Honor the parents' request not to tell Tara.
- Tell Tara.