HA550 Unit 8 Adolescent Chemotherapy Refusal Ethics Example

Sixteen, Two Cycles In, and Saying No: A Bioethics Framework Application Working a Composite Adolescent's Refusal of Curative Chemotherapy for Hodgkin Lymphoma Through the Four Topics Method and Then Casuistry, Between the Adult Who May Refuse and the Young Child Who May Not

[Student Name]

Purdue University Global

HA550: Health Care Law and Ethics

Unit 8 Bioethics Framework Application

[Instructor Name]

[Date]

The patient, family and figures are composite and bracketed for the writer's own data; the frameworks are real, and state law on minors varies.

The Case

[Maya], [16], was diagnosed with Hodgkin lymphoma [three] months ago. After [two] of [six] planned cycles, with nausea, hair loss and missed school, she said she would not continue. She explained that she felt sick all the time, that she had read about natural treatments and that she would rather live her life now. Her parents, who distrust the hospital after a relative's death there, support her. Without treatment, the oncologist expects the disease to return and, in most cases, to be fatal within a few years.

Listening Before Weighing

Before either framework can be applied fairly, the team has to understand what the refusal means to her. In a longer conversation with the palliative care clinician, [Maya] said the worst part was not nausea but missing her final season on the volleyball team and feeling that no one asked what she wanted. Her parents' distrust came from a relative's death they believe was mishandled. Neither concern is a reason to accept the refusal, but both are reasons the refusal may soften if the team changes how treatment is delivered and who delivers the message.

Application 1: The Four Topics

The Four Topics method sorts a case into four boxes (Jonsen et al., 2022). Medical indications. A highly curable cancer; [two] cycles given; side effects significant but temporary; without treatment, likely death. Patient preferences. A clear, repeated refusal from a minor who gives reasons. Her decision-making ability should be assessed rather than assumed: does she understand the cure rate, the consequences of stopping and the alternatives? An interview with the oncologist, a psychologist and a palliative care clinician found she understood the facts but believed she would beat the disease naturally, a belief contradicted by the evidence. Quality of life. Four more months of treatment burden weighed against the prospect of decades of life afterward. Contextual features. Parental support; distrust of the hospital; state law on minors' consent; the hospital's duties if it believes a child is at risk. The grid organizes the facts but does not say which topic should win.

Application 2: Casuistry

Casuistry reasons from clear cases, called paradigms, toward hard ones by analogy (Jonsen & Toulmin, 1988). Paradigm A: a competent adult with Hodgkin lymphoma refuses chemotherapy. The refusal is respected, even if it is likely fatal. Paradigm B: parents refuse curative chemotherapy for their six-year-old. Courts generally order treatment, because a young child cannot decide and parents may not refuse life-saving treatment on the child's behalf. The question is not which principle wins, but which paradigm her case sits closer to. Features that move her toward Paradigm A: she is sixteen, articulates reasons, has experienced the treatment and has her parents' support. Features that move her toward Paradigm B: the cure rate is high, the refusal is irreversible, the burden is temporary, and her reasoning rests partly on a mistaken belief about natural treatment. On balance, the case sits closer to Paradigm B. A high cure rate, an irreversible outcome and a refusal based on a factual error all weigh against treating her choice as an adult's. Had the cure rate been [20] percent, or the treatment burden lifelong, the case would move toward Paradigm A.

A Principlist Reading

A principlist reading would frame the conflict as respect for autonomy against beneficence. That framing is accurate but less helpful here, because a minor's autonomy is developing rather than complete, and the principles do not say how much weight it carries at sixteen. Casuistry supplies that weight through comparison.

Legal Context

Some states recognize a mature minor doctrine allowing certain adolescents to make their own treatment decisions, usually when the risk is low; few courts have applied it to refusals of life-saving treatment with a high cure rate. In 2015 the Connecticut Supreme Court upheld court-ordered chemotherapy for a seventeen-year-old with Hodgkin lymphoma. Pediatric guidance stresses seeking the adolescent's assent and involving her meaningfully in decisions, while recognizing that parents and clinicians may sometimes override a refusal when the stakes are high (Katz et al., 2016).

What the Hospital Should Do

Before any legal step: address the side effects with better supportive care, involve a clinician the family trusts, perhaps from another hospital, and explore what "living her life now" means in practice, such as adjusting the schedule around school events. If she still refuses, the ethics committee should meet with the family, and only as a last resort should the hospital seek a court order, knowing that forced treatment may damage trust for years.

Conclusion

The case sits closer to the child who may not refuse than to the adult who may. That conclusion permits, but does not require, overriding her refusal; it requires first trying everything that might make overriding unnecessary.

References

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2022). Clinical ethics: A practical approach to ethical decisions in clinical medicine (9th ed.). McGraw Hill.

Jonsen, A. R., & Toulmin, S. (1988). The abuse of casuistry: A history of moral reasoning. University of California Press.

Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161485. https://doi.org/10.1542/peds.2016-1485