Ethical Issues Raised by the Media Portrayal of Adolescent Transplant Refusals.

Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: MEDLINE

Publication: Elk Grove Village Il : American Academy of Pediatrics
Original Publication: Springfield, Ill., Thomas.

Bioethical Issues*; Mass Media/*ethics ; Organ Transplantation/*ethics ; Parental Consent/*ethics ; Treatment Refusal/*ethics; Adolescent ; Family ; Female ; Humans ; Informed Consent By Minors/ethics ; Informed Consent By Minors/legislation & jurisprudence ; Male ; Organ Transplantation/legislation & jurisprudence ; Parental Consent/legislation & jurisprudence ; Patient Participation ; Patient Self-Determination Act ; Principle-Based Ethics ; Treatment Refusal/legislation & jurisprudence ; Twins, Monozygotic ; United Kingdom ; United States

Cases of adolescents in organ failure who refuse solid organ transplant are not common, but several have been discussed in the media in the United States and the United Kingdom. Using the framework developed by Buchanan and Brock for surrogate decision-making, I examine what role the adolescent should morally play when deciding about therapy for life-threatening conditions. I argue that the greater the efficacy of treatment, the less voice the adolescent (and the parent) should have. I then consider how refusals of highly effective transplant cases are similar to and different from refusals of other lifesaving therapies (eg, chemotherapy for leukemia), which is more commonly discussed in the media and medical literature. I examine whether organ scarcity and the need for lifelong immunosuppression justify differences in whether the state intervenes when an adolescent and his or her parents refuse a transplant. I argue that the state, as parens patriae, has an obligation to provide the social supports needed for a successful transplant and follow-up treatment plan, although family refusals may be permissible when the transplant is experimental or of low efficacy because of comorbidities or other factors. I conclude by discussing the need to limit media coverage of pediatric treatment refusals.
Competing Interests: POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.
(Copyright © 2020 by the American Academy of Pediatrics.)

Date Created: 20200802 Date Completed: 20200903 Latest Revision: 20200903

20221213

10.1542/peds.2020-0818H

32737230