The first question that we are to consider asks us to address many of the actual issues that come up in the course of medical decisions, and not simply in terms of cancer treatment. It is often the case that parents and children will not agree over a proposed treatment for the child; the ethical conflicts that can follow such a disagreement can be extremely traumatic. This is especially problematic for the family given that they are already suffering through the trauma of health problems, often terribly serious ones.
In the case study with which we are presented we lack certain key pieces of information that we would have in a real-world case and that are in fact necessary for us to have in order to make a finely balanced ethical decision (Brody, 1988, pp. 36-8). The first of these is the age of the child. A child cannot be expected to make a reasonably informed medical decision when s/he is under the age of ten. Alternatively, a child can in many cases make a reasonably informed medical decision at the age of seventeen. The intervening ages are more difficult to assess and depend in no small part on the maturity level of the child and the risks associated with the procedure.
This is another key piece of information that we do not possess about the decision that is to be made. Is the medical procedure one that is needed to save the life of the child? If so, then it seems to me that the doctors should indeed put pressure on the parents to get the child's consent. It is likely that in such a case the parents are so scared about their child's future that they may simply be paralyzed by the ethical questions with which they are faced and so need some informed encouragement from medical professionals (Tauber, 2005).
If, on the other hand, the medical procedure is unlikely to save the child's life but will rather reduce pain or increase lifespan, then the doctors should put less pressure on the parents. They should instead be as clear as possible in laying out both benefits and dangers to both parents and child. Among the benefits of the procedure may be that it will help researchers and doctors in the future assess how effective the treatment is for other children. Considering this is certainly not unethical on the part of the physicians, but it must be made clear to the family that this is part of the dynamic.
Among the other pieces of information that the doctors must make clear to the parents is the statistical likelihood that the procedure will prove to be effective. Once the parents have assessed this information, they will be more able to determine for themselves how they (and the doctors) should proceed.
Related to this issue is the fact that the doctors must assess how well educated the parents are. Informed consent is one of the most important concepts that there is in medical ethics but it is by no means a uniform practice. Providing informed consent to another physician is an entirely different practice than is providing informed consent to someone with a third-grade education. (And this is especially true if the latter is in fact eight years old.) One of the ethical questions that physicians must always make is to determine how much information about any procedure must be disclosed to the patient (and family or other supportive individuals) to allow the patient to make just the right decision without being either under-informed or drowned by information.
In terms of providing informed consent, another issue that is not explicitly addressed in this vignette as it is presented to us are the religious and/or spiritual views of the family. The medical staff must consider how the family's ethical values mesh with the ethical values of Western medicine as they assess whether it would be appropriate to pressure the parents to get the child to provide consents. All of these issues must include the fact that in almost all cases, the child has to abide by the decisions made by the parents for his/her care.
In cases in which the child has an extreme difference of opinion with the parents, then s/he may try to turn to the courts to get a different outcome. The physicians have an ethical obligation to inform the family of this option (Ryan, 2010).