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The Case:

12-year old, Maximillian is suffering from cancerous tumours in his brain and spinal cord. His physician, Dr. Jones, deems that the tumours are not currently life threatening though she expects they will become so if they are not treated.

Everyone involved in Maximillians case wants to promote his best interests. There is, however, disagreement about the best way to do this.

Dr. Jones has recommended a plan of treatment that includes radiation to shrink the tumours. She has explained the process of administering radiation to Maximillian and his parents. She has also presented the expected benefits and risks associated with the plan of treatment proposed. Dr. Jones estimates a 70% chance that radiation will eliminate the tumours and she has explained that she judges radiation treatments will give Maximillian the best chance for a full recovery without the need for more invasive interventions. Dr. Jones has explained that chemotherapy and surgery may be recommended if the size of the tumours increases. She has been happy to answer any of the familys questions.

Maximillian has been involved in all of the discussions about his treatment with Dr. Jones. Dr. Jones judges that Maximillian is very intelligent and wants him to understand both the nature of his tumours and the treatment recommended.

Maximillian has stated that he doesnt want radiation. He is worried that this is going to make him feel really sick and really tired. He is especially concerned that he wont be able to play on his schools soccer teamone of the best teams in Quebecthis year.

Maximillians parents have stated that they dont want Maximillian to undergo radiation. They believe the best option is to feed Maximillian a vegan diet of organic vegetables, free of sugars and free of animal products. This plan, they believe, will allow Maximillians body to heal itself with the right nutrition.

Following Maximillians desires and their own beliefs, Maximillians parents have informed Dr. Jones that they are refusing radiation treatment and they have indicated this in writing.

Dr. Jones believes that Maximillians parents are making a loving, but nevertheless irrational, decision and has petitioned the courts to intervene so that Maximillian will be treated with radiation before his tumours become life threatening.

The Assignment:

Draw on the relevant readings from Modules 1 and 2 to complete the tasks identified in one of the following options. (You should choose only one of option 1 or option 2 or option 3.)

1. State whether or not Maximillians parents are making an informed decision in one or both of the two senses introduced by Faden and Beauchamp and support your judgment. If you think they are making an informed decision to refuse radiation treatment in both senses, could the courts have any grounds to deny their refusal and order that Maximillian receive radiation treatment? If you think their decision to refuse treatment is not informed in both senses, who should have the power to make medical decisions for Maximillian in this instance? Defend your answers.

2. This option involves answering two questions. Are Maximillians parents making an informed decision according the transparency standard model as this is presented by Brody? In answering this question, make sure to explain what the transparency standard is, how this standard could be used to assess the parents decision-making, and why you think the standard is met or not met in this case. Is meeting the transparency standard sufficient in this case? (In other words, should more rigorous standards be applied?) Defend your answers.

3. Use the four principles of biomedical ethics outlined in Chapter 1 of your text to make clear the ethical issue that arises in Maximillians case. To do this, identify which principles are most relevant to understanding the case and explain how the principles you identify conflict in Maximillians case. (It might help to draw on the concept of paternalism to explain the conflicting principles.) Then, say whether you think the parents should be allowed to make the decision for Maximillian and defend your answer by saying why certain principles should be given more weighting than others.

Do you need an answer to this or any other questions?

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