Pediatric Oncologists Should Help With Difficult Decisions

[MountainLaurel]

The oncologist should be the primary decision maker in some pediatric cancer situations, say researchers at Baylor College of Medicine (BCM) in Houston in an article appearing today in the Journal of Clinical Oncology.

"The conventional wisdom is that the patient (or parents) should always make the decision because that is their right and duty. We believe that is too simplistic; parents expect and need help from the clinician with difficult decisions," said Dr. Simon Whitney, assistant professor of family and community medicine at BCM.

Whitney, also an associate faculty member of the Center for Medical Ethics and Health Policy at BCM, says the most important thing for clinicians to understand is that there must be a constant dialogue between patients and clinicians. Patients look to clinicians for authority in decision making yet clinicians should know how to read, listen and explain the information so that parents thoroughly understand the options when they have to make a treatment decision.

Treatment options are complex and decisions must sometimes be made at a moment's notice. When there is one clear best way to treat the patient the physician should inform the parent and child of the one treatment option as if it is the only one, including any risks associated with the treatment.

http://www.medicalnewstoday.com/medicalnews.php?newsid=35485&nfid=rssfeeds

Anyone else disturbed by the idea of a physician withholding information?

[SharonAnn]

1. Yes, espececially if it is a Bush or a Cheney. "Trust us, we know best"

[Deep13]

2. theoretical truth versus practical truth

Nontreatment is always an option as are half measures, but when one course of treatment is the only one with any real chance for success, is it really dishonest to say it is all that is available when the doctor knows that anything else will fail? The way I would put it is that X, Y and Z have been done, but with only marginal success, meaning most of the patients have died. The only real chance for survival is A, but it has serious side effects and the chances of recovery are . "So are you saying we should do A?" Answer, "Yes if you are willing to allow the child to suffer for chance at survival."

I frankly found it frustrating when the nuerologist was noncommital following my father's stroke. His language cautioned against optimism, but he would not say it was hopeless. "Motality rates a pretty high with this kind of injury," was typical. He said he could try X, Y and Z drugs but created the impression of pessimism. What I wanted was either, "Sure there are things we can do, but as a practical matter, this injury is too severe for any real chance at success," or "I don't really know. It is a bad stroke, but we might as well try this stuff and maybe he will improve." I found his evisive answers to be infuriating. What the hell did we have an expert for if we could not get a straight answer out of him?