This is a very hard case to comment on. On one side, Jimmy should be allowed to decide whether or not he wants to suffer through HIS life or bypass the suffering, but on the other hand he is only 11 years old, and some would say that at that age a child is too young to truly understand the magnitude of the given situation. I believe that the child should consult with both his physician and his parents before making such a decision, but yet again, it is his life, and he is the one who has to live it. I understand that his parents do not want to live without him ever, much less lose him at such a young age, but what kind of extension to life are they giving their son, when his extension would include pain and suffering? If the parents ultimately make the decision to keep their son around a little bit longer, they will most likely have regret for putting him through the extra pain, and possibly for letting their son pass with little dignity, when they had the chance to allow him to pass with some dignity still at hand. I believe that the oncologist needs to consult with the legal board and make sure that Jimmy is allowed to make such a decision, and the doctor should then consult with both Jimmy and the family separately, and then together in order to get a truthful answer from each of them. After the oncologist has done his consultation, it is hard for me to say what I think he should do. I want to say that he should honor Jimmy's wishes, but on the other hand, does the CHILD have the adequate mental and reasoning ability to make such a decision? This is a very difficult case to choose sides on, there are just so many factors that play into this decision.
Minors of Jimmy's age should be allowed to participate. The final verdict needs to be up to their parents, but if a child is deemed by a child's psychiatrist as being capable of making such a decision, then their opinions need to be taken into account by their parents or guardians.
The parents decision needs to be the decisive one, simply to preserve parental rights for other medical situations in which parents need to be the ones in charge, or for situations in which the children are not old enough or mature enough to be able to make their own decisions.
The oncologist should listen to the parents, as this is the current law, although she should make sure that they understand the implications of going against their child's wishes on a matter of this importance.
This case is a difficult case to navigate because the child in question is far underage. If he were closer to being an adult, then different provisions should be made, but in this situation, it is ultimately the parents responsibility to do what they feel is best for their child. That being said, it is important that doctors make sure that the parents are as well informed as they can be about the repercussions of the treatment, the effects of withholding treatment, and consider having them see a hospital social worker or counselor before continuing with treatment.
Minors of Jimmy's age should be permitted to participate in decisions such as this. The child should ultimately make the decision for himself. He is the one that would be experiencing the pain of chemotherapy, loss of ability to talk, walk, use his hands, and control his excretory functions. It is completely understandable that the parents do not want to see their son suffering, and would have a difficult time coming to terms with his decision. In the oncologists case, they should leave the decision up to the family and respect their wishes. They might advise the family on what might happen if they chose either way, but in the end, it is the family's choice.
Considering Jimmy’s terminal condition and his understanding/knowledge of the suffering he’ll endure due both to the lymphoma and the incurable neurological condition I believe Jimmy should be involved in his care choices and have the right to make his opinion known to his care provider and his family so they know his wishes. However, due to his age Jimmy’s parents’ choice about treatment will be the deciding factor. Because of Jimmy’s minor status the parent’s decision about what care Jimmy will receive is decisive. This is important because it protects their right to make choices about their children‘s well-being as long as it is not harmful to the child. This would be a complex situation for any health care provider to approach. However referral to counseling, possibly even a grief counselor because even though their son is still living they are dealing with the very harsh reality of his mortality, may help them see Jimmy’s point of view on the treatments and his wish to stop fighting. Furthermore, the parents need to understand the effects that putting their son through this treatment may have on him and the probability of success in a case like Jimmy’s. If the parents still disagree with or ignore their son’s wishes then the oncologist would have to proceed with chemotherapy because it still is their right to give consent to treatment.
I believe that minors should be permitted to participate in decisions of this magnitude. It is their life to live, why shouldn't they be aloud to participate in this type of decision? I do not think that Jimmy's decision should be the final decisive decision, but I also believe that the oncologist should not decide fully on what the parents think either. Jimmy is not going to have a normal life, his parents should understand that even if the treatment is successful he only has an expansion of months to his life. In those months, his neurological disorder could worsen and he could become wheel-chair bound and not able to talk or make decisions for himself at that time. This is a better time for him to make a decision because of that situation. If Jimmy is able to have such a strong connection with God at such a young age, his thoughts and views about his life should be taken into consideration by the physician. I think the doctor should gather a counsler and chaplain to discuss this situation with both parents and Jimmy together. Jimmy needs to be able to discuss with his parents about his decision and the parents need to be able to discuss their views and reasoning for their decisions. Support from the counsler and chaplain can help both parties get through the situation together. The oncologist should talk to the parents about Chemotherapy and the complications from therapy and how harsh it can be on one's body. The oncologist should also explain that Jimmy will only live for months longer and might be in significant pain if they decide to go with the treatment and is it extends his life for those couple of months. Jimmy is young, but any situation like this should always include the patient. They are the one that will have to live their life, no one should make such a strong and hard decision for them.
I know that parents always want to do the best for their children, but sometimes I feel like they are blinded by their own wishes. If I was Jimmy, which I thank God everyday for blessing me with good health, I could not imagine being forced to go through chemo. The side effects of the treatment will most likely not be worth the extra three to six months of life that in which Jimmy could possibly lose more bodily functions due to his neurological disease. I agree with Camille and Marion in that fact that 11 is probably too young to be mental competent to make the decision. However, their input on the subject should be taken seriously.
The case is difficult because many do not see an 11 year old capable of making the decision to live or die. I very much agree with Marion that if a child is seen capable by a psychiatrist, the decision should be theirs to make. If Jimmy is seen as mature child, who with his strong faith in God, fully understands the outcome of his decision, then it should not be up to the parents to decide for him. We talked in class a little bit about letting go of your loved ones. The parents in this situation are not ready to let go, but rather prefer their child undergo treatment that is only 20% effective and live a very painful life. If the child is ready to let go, the parents should also prepare themselves to go. The oncologist, although put in a hard situation, must respect the final word of the parents to abide by laws. I feel that the oncologist needs to make sure the parents fully understand the outcomes and circumstances that their child will endure. The chemotherapy may temporarily increase his lifespan, but his neurological disease will still progress decreasing his quality of life. Jimmy would no longer be capable of doing the childhood things they picture their child doing after recovery because he will be unable to walk, talk, and use the hands effectively. The oncologist should offer the parents other resources to talk to and give time for them to communicate thoroughly with their child before beginning treatment if the parents still override Jimmy's decision.
I do believe that minors should be permitted to participate in decisions of this magnitude. Jimmy and other minors like him will be in situations where a disease will take their body, and in the process, cause THEM pain. It would be selfish of everyone in the decision-making process if they did not at least consider Jimmy’s choice because nobody else in the Patient-family-doctor-nurse- relationship is feeling Jimmy’s PHYSICAL pain.
Whether or not the child should make the choice to die or not is a little more complex. In a previous statement, I said that the parents and doctors should consider his choice, but Jimmy is 11. Eleven is awfully young to be making life-and- death decisions, so I believe that IF THE CHILD HAS A CHANCE OF LIVING LIFE, absolutely the parents should fight to prolong his life, but in the case of Jimmy, he will be dead in less than a year. Even if Jimmy did not die, his neurological problem would be so debilitating, that Jimmy would not be able to LIVE. Yes, his body will continue pump blood to his muscles, but Jimmy would not truly live a happy life. And to top off Jimmy’s pain of living 12 months, his parents won’t be able to help Jimmy’s condition at all. Knowing this, his parents would only encounter ever more increasing emotional distress in the 12 months Jimmy has to live. Nobody wins in this situation.
The fact that nobody wins is what the oncologist should see. Jimmy has no more than 12 months left to live, he will be debilitated from his declined neurological functioning, he will be in pain, and his parents will be an emotional wreck for 18 months compared to 12 months (just a random guess on grieving periods). Jimmy is in pain and nothing will make Jimmy live a happy life. The oncologist should realize that everyone loses if his life is prolonged and more pain is produced. For everyone. I personally believe that it would be in everyone’s best interest if Jimmy’s wishes were followed.
-I found this summary interesting: Most ancient Greek thought about the nature of human life was governed by two fundamental assumptions and these are the basis of Aristotle's approach to the study of ethics:
• That human life is comprehensible only when conceived of as being directed toward some end or good, and that it can be interpreted by a categorization of ends and means. In the sense that human life is thought to contain an ideal element, most Greek moral philosophy, including Aristotle's, is idealistic. Since Aristotle's moral system is concerned with determining ultimate causes and ends it can also be considered teleological.
• That the end toward which all practical human activity is directed is definable in advance of its realization. This takes moral knowledge out of the realm of abstraction and speculation, and gives it great practical importance as a code for personal life and a guide for the organization and administration of the political state.
i feel that Jimmy should get some say in what happens to him. It is his life, but I do not feel an 11 year old can make such huge decisions with out guidance. I feel for his parents, but I do believe that He should get some say in his treatment. I would personally send them to counselling to work through there different opinions to come to an understanding. I think the oncologist should work with the family for counseling and grieving. The boy seems to understand his situation well, but I think his intentions and reasoning for why he doesn't want to fight should be asked. He's very young to be so ready for death. Maybe someone needs to take time to talk to him about what he is feeling. I wouldn't want my son to feel that ready for death at such a young age.
I feel that, even though he is only a minor, Jimmy should have a say in his cancer treatment. Due to his neurological disorder, he has already dealt with more medically than most of his peers. This makes him more qualified than most 11-year-olds to make a decision of whether to utilize chemotherapy.
If Jimmy were only facing lymphoma, his parents would be more justified in wanting to do everything possible to attempt to cure the cancer. However, both Jimmy and his parents have been aware for some time that he will not survive to adulthood, and if he does, he will be largely incapacitated and incapable of living a "normal" or pain-free life. Because he is facing death regardless of whether or not he receives chemo treatments, I think he should have a say in whether or not to attempt to fight the cancer.
The parents will have the final decision for legal reasons. However, I feel they should listen to Jimmy and hear what he has to say before making a choice. As a parent, I cannot imagine making this decision. But forcing their son to deal with the discomforts of chemotherapy against his wishes does not seem to be the way to go, especially with the grim prognosis.
Jimmy's parents had been preparing to face his death since before his cancer diagnosis. They knew they would likely outlive their son, and I can understand why they would want to have as much time with him as possible. But in my opinion, watching their child suffer silently, unable to communicate, move, or even relieve himself properly is not doing him any kindness. His parents need to look at the situation from Jimmy's perspective before putting him through painful (and likely unsuccessful) chemotherapy treatments.
The oncologist has a responsibility to both parties. She needs to listen to Jimmy's wishes and to hear his reasons for declining chemo. She will ultimately have to obey his parents' wishes, though, so she needs to understand exactly what they are saying, too. The oncologist also has a responsibility to help communicate the pros and cons of each decision to both Jimmy and his parents. If she is able to provide them with all of the facts, hopefully they will be able to come to an understanding.
Even though Jimmy is only 11, he seems to understand the situation he is in if he does the chemo treatments to help with his lymphoma and also how he is going to only live to 18 years old with his neurological disease. I think he and other minors should be able to participate in decisions like this because they are only participating, not overriding their parents' decision. I don't think 11 years old is too young to make a decision like that, for example because Jimmy has already accepted dying at a young age which is hard thing to do at 11. So, I think kids that age can handle a decision like that. Parents' should listen to the child's thoughts on the decision and factor them into the final decision because it is the child that is going to be going through all the treatments along with the horrible side effects, not the parents. However, the parents' decision should be decisive because the child is still only a minor, so the doctor would have to listen to what the parents decide. Maybe there could be a law created to where the parents had to factor in what the child wants into the final decision. The oncologist could probably understand where the Jimmy is coming from, and I think she should fight for Jimmy because as Jimmy's doctor she is supposed to fight for the wishes of her patient. She should try to convince Jimmy's parents where he is coming from, but also sympathetic with the parents because it truly is hard to lose a child at such a young age. Someone just needs to be there to help the parents get through this situation and help them understand that Jimmy doesn't want to go through all that pain.
This case is a tough to decide on who is right and what should be done. I think personally that if this was a patient of mine I would fight for what Jimmy wants because he is the one that would have to go through all the chemo and the bad side effects. Who knows he might die from a complication from one of the side effects from the chemotherapy. I just hope that even though Jimmy's parents are going through a tough time they can understand where he is coming from and accept like he has the fate that God has given him. With God, they will be able to make it through anything.
In my belief, minors of Jimmy's age should be permitted to participate in decisions of refusing treatment. I feel that it should be up to the child to decide whether they want a life with or without terrible side effects that could come with treatment. That is only giving the child about the same time that has already been indicated by the oncologist without treatment. Shouldn't Jimmy's quality of life be considered??
Gilbert Meilaender is recorded saying, "Life is not our God, but a gift of God; a death is a great evil, but not the ultimate evil. There may come a time, then, when it is proper to acknowledge death and cease to oppose it. Our aim in such circumstances is to care for the dying person as best we can - which now, we judge, means withdrawing rather than imposing treatment."
As for the oncologist, i would agree with Melissa and recommend the parents, as well as, the child to go to a counselor. The counselor then could help the family move toward a final decision, in which, is best for the child, seeing that the child will be enduring the illness and possible treatment that could put him in even more pain.
Decisions of minors should be assessed to make sure that they fully understand what is going on and what their options are. If the child can fully understand the situation it should be the child's decision. Granted most children at that age know would probably know what is going on, but they may not completely understand. The oncologist should sit down with Jimmy and his parents and talk with them about the situation, or allow the family some alone time to really discuss it with themselves. Jimmy seems to understand his situation, as he has accepted everything. I think his parents should sit down and tell Jimmy how they feel about his decision and he should explain to them how he feels. I don't think it's right for his parents just to step in and make this decision for him. Even though he is 11 years old, I think that given the situation he would be able to make a mature decision. If I were in his place I would want my parents to respect my wish. On the other hand I am not religious and I would want to undergo the chemo for my family. I know they would want me to and I'm very close to them so I'd want as much time with them as possible even if it put me through pain. This may be due to the fact that I would also not be ready to leave them at such a young age, and it would hurt me more to see them hurt than for me to experience pain to myself.
I believe that minors of Jimmy's age should be allowed to participate in decisions of this magnitude. If the child understands the illness and treatment then he should be allowed to participate. After all in the end it is his life and he is the one who is going to be living it. It is hard when a loved makes a decision about a life and death situation that the family does not agree with. It is also selfish for the other parties to ignore that patient's participation in his or her life. I do not think that Jimmy should make the final decision, but the parents need to understand that the treatment will only keep Jimmy living for a few more months. Also those months may not be worth living for Jimmy especially if his neurological disease progresses. I think the parents need to make sure they are thinking about Jimmy and his needs to make this final decision. I think the oncologist should follow what the parents decide due to abiding by the law but he or she needs to sit down with the parents alone and discuss their son's health conditions. This situation is even harder to deal with because it is a child who is sick. I think people need to understand that children are capable in participating in these types of decisions and their wishes should not be overridden just because they are at a younger age.
I believe that Jimmy should be able to make the decision for himself. He is the one who will have to go through all the pain. The doctors have told him that he will die and cannot be cured. He has been through a lot and is so young. I feel he is mature enough to decide. He is religious and knows that he will be with God. I can understand why a parent would want to keep the child alive, it is their baby boy. But he will be in so much pain with the chemo. I think, if I was in Jimmy’s position, I would rather pass away, and enjoy what little life I had left.
This is a very tough scenario. Personally, I believe that minors of Jimmy's age should be allowed to participate in these kind of decision making situations, too! I'm trying to put my self in Jimmy's shoes and it is so hard to take in and comprehend the medical situation he was going through. He is the one bearing a serious magnitude of pain, besides all the medical assistance that might be offered to him. Jimmy's situation is so hard because he was suffering from two deadly diseases, and one of them being incurable.
Since it is Jimmy who goes through the pain and agony, his decision should be taken into consideration. Parents will forever try as much as they can to help alleviate the situation. However, when the parents' decision is finally used as the verdict, by doing this they shall have gone against the will of their son, Jimmy in this case! This does not imply that Jimmy's parents should not play a role in the decision making and have hope, but putting into consideration and weighing the chances of Jimmy living (with regard to the diseases that befell him).
The oncologist is in a tough decision making situation as well. She 'indicated that the chemotherapy provides an effective cure to 20% of cases like Jimmy's'. the oncologist should therefore try persuade Jimmy into believing this and give it a try....but if the patient does not agree completely, then doing that against his will and consent will be a very big mistake done! I think the oncologist should talk to Jimmy in the presence of his parents vividly elucidating the great chances of him living longer by undergoing through the chemotherapy. Besides, she should also bring up the religious discussion that he has faith in God and that all the medical attention that will be pursued should help too at the end of the day! Overall, I think if both the oncologist and Jimmy's parents accept Jimmy's wish and will, it would not mean that they have given up on him, instead it is being respectful to their child's will and decision. Otherwise, this was a serious and tough situation that the parents, oncologist and Jimmy had to go through! Situations like this happen across the world, and it is so terrifying if not only saddening.
I believe that everyone has a decision in critical times even if you are the same age as Jimmy.Everonye has a freedom of speech and equal opprotuinity to voice their opinion. When you have someting as severe as Jimmy's condition, I think it is right to have the minors say even if it is the parent's who make the final decision. This way, the parents or guardians know the wishes of the minor and shouldn't feel guilty for what the outcome may be. I think that both Jimmy and his parents have a equal decision about his situation. Even if Jimmy's decision is overridden by the parents, he at least will be able to know he told them what he wanted to do. In the case Jimmy knew he was aware of the situation and that even without lymphoma he may not have lived till 18. Overall, it is the parents final decision because the are liable for Jimmy and have the right of him. With any doctor they should always hear both sides of the story. The oncologist should sit down and hear Jimmy's requests about getting treatment and also the parents. It shouldn't matter if Jimmy is a minor or not because in the end you know why he would have wanted. I know it could be hard for the oncologist emotionally, but with him/her knowing the situation, it will be easier to make a final decision and support the decisions of Jimmy and his family. It would be hard if i was the parents in this situation because I would feel guilty not trying to help save my child's life or postpone it. It would be very emotional because you know as a parent you have the last say. I would feel better knowing that Jimmy is close to God and knows the outcome and isn't afraid. The parents should be happy that with the religious belief in the family that Jimmy is at peace and is not scared for what may come. This case is very hard for everyone and would still be hard even if Jimmy wasn't a minor. It would then be Jimmy's decision to weather or not he wanted to have treatment and the parents voice would want to be heard then .
I believe that although Jimmy may not be fully capable of making the decision on his own, he can take part in it. After all it is his life, but I do understand that he is only eleven years old and may not be able to fully comprehend his situation. Then again many children that are put with these situations can grow up fast. His parents also have a big part in the decision. I think the best situation would be if Jimmy and his parents could sit down and talk about the decision. Maybe after they talked the parents would understand where Jimmy is coming from and vice versa. Since Jimmy is a minor, I still believe his parents should play a bigger part in the final decision. I also believe that before they make the decision they need to consult Jimmy. If the oncologist knows that Jimmy and his parents' views are conflicting, maybe he could sit down and talk with both of them. The doctor and a psychologist could maybe explain to them all the details in either situation. No matter what the decision the parents make, I still believe they need to take in account and at least listen to Jimmy's opinion.
This is a very unfortunate situation, but an extremely realistic one as well. Pediatric oncology is nothing short of upsetting, but as nurses we must face the fact that we will see this at one point or another if we haven’t encountered it in our personal lives already. While the parents of this situation do not want to live their life without their son, Jimmy, he should definitely be able to participate in the decisions that are made about his life. However, with him being only 11 years old, it would be difficult to leave the decision solely up to him. If the parents were to make the final decision, I believe the oncologist should advise them to also take their son’s wishes into major consideration. It is his life, and if he is accepting of his death and ready to be with God, then the parents need to begin the accepting process as well. While the chemotherapy might extend Jimmy’s life by a few months, what kind of few months will that be for Jimmy? Surely it would be months of more pain and suffering with the same outcome as if he did not receive the treatment at all.
I agree with many of these post. I think that Jimmy has the right to decide what he wants for himself. I know this is a young age, but if he believes that it is the right thing for himself and that he is ready to go to God then he shall. I don't think it is a young age to decide what hey needs for himself. I know that the parents don't want to lose their child at a young age, but life throws us a curve ball and we have to handle the situation no matter if we don't want to. The way the oncologist should handle the situation would be to talk to both the parents and Jimmy because since he is a minor they should have to finalize on one thing, but I believe that Jimmy has the right to what he wants for himself. The parents need to accept what is happening in their life and enjoy the final days that they do have with their son.
As most of my classmates have said, Jimmy should absolutely be involved in the decision making process. Even if he was not involved and they continued with treatment, if a pt does not want to participate they will be less likely to benefit. In Jimmy's case, he is probably beyond the emotional maturity of a typical 11 year old, for this reason, a psych consult should be acquired to determine his understanding and knowledge of the situation. MD's cannot forget that underneath the disease there is a pt, regardless of his age, he has a right to understand and at least assist in the decision making process. The oncologist should assist the pt by helping him to understand, but also, helping the parents to understand the risks and benefits and the reasons why their child feels this way. Ultimately, Jimmy's opinion should play a big role in the decision making process, but I feel a psychologist, case worker, and oncologist specializing in pediatric cases should be consulted.
I also believe that Jimmy should have a chance to give input about his treatment. I agree with Katie's point that Jimmy's maturity level is probably a lot higher than that of a typical 11 year old. He has obviously been through a lot in his short life, but he has comfort in knowing that he is going to go to God. I understand the parents' need to keep Jimmy around as long as possible. However, do they want to see Jimmy be useless and sick all of the time? I don't think I would want to see that from my child. If he is ready to let God have His will, then the parents should support their son. I agree with many that he should not be the only one making the decision, but I think Jimmy's input should have a large impact on the decision being made.
In this case, I believe Jimmy should be able to make his own decisions on his own life. He is fully competant and knows what the future holds for him. I dont think Jimmy should give up because a prognosis is just that, it is not definate, but I'm presuming Jimmy has already been through a lot and may not be able to handle much more. Based on Jimmy's prognosis I believe his decision should be taken not his parents. I feel that they are just being selfish. If Jimmy wanted purposefully to die then the parent's decision could be taken. The oncologist should inform the parents of all options and suggest to follow Jimmy's decsion but in legal matters he has to follow what the parent's decide.
I believe Jimmy should be able to make this decision, because of him going through the situation he knows the ends and outs of it all and he knows he doesnt want to put himself in that state and put his parents in that position. Any one at his age if they know the situation, consquences, etc. should be able to make the decision themselves because it is their life in the end and it doesnt belong to anyone else. The doctor should look at all sides assess his feelings to and see if he would be able to go through with either decision.
This is a very hard case to comment on. On one side, Jimmy should be allowed to decide whether or not he wants to suffer through HIS life or bypass the suffering, but on the other hand he is only 11 years old, and some would say that at that age a child is too young to truly understand the magnitude of the given situation. I believe that the child should consult with both his physician and his parents before making such a decision, but yet again, it is his life, and he is the one who has to live it. I understand that his parents do not want to live without him ever, much less lose him at such a young age, but what kind of extension to life are they giving their son, when his extension would include pain and suffering? If the parents ultimately make the decision to keep their son around a little bit longer, they will most likely have regret for putting him through the extra pain, and possibly for letting their son pass with little dignity, when they had the chance to allow him to pass with some dignity still at hand. I believe that the oncologist needs to consult with the legal board and make sure that Jimmy is allowed to make such a decision, and the doctor should then consult with both Jimmy and the family separately, and then together in order to get a truthful answer from each of them. After the oncologist has done his consultation, it is hard for me to say what I think he should do. I want to say that he should honor Jimmy's wishes, but on the other hand, does the CHILD have the adequate mental and reasoning ability to make such a decision? This is a very difficult case to choose sides on, there are just so many factors that play into this decision.
ReplyDeleteMinors of Jimmy's age should be allowed to participate. The final verdict needs to be up to their parents, but if a child is deemed by a child's psychiatrist as being capable of making such a decision, then their opinions need to be taken into account by their parents or guardians.
ReplyDeleteThe parents decision needs to be the decisive one, simply to preserve parental rights for other medical situations in which parents need to be the ones in charge, or for situations in which the children are not old enough or mature enough to be able to make their own decisions.
The oncologist should listen to the parents, as this is the current law, although she should make sure that they understand the implications of going against their child's wishes on a matter of this importance.
This case is a difficult case to navigate because the child in question is far underage. If he were closer to being an adult, then different provisions should be made, but in this situation, it is ultimately the parents responsibility to do what they feel is best for their child. That being said, it is important that doctors make sure that the parents are as well informed as they can be about the repercussions of the treatment, the effects of withholding treatment, and consider having them see a hospital social worker or counselor before continuing with treatment.
Minors of Jimmy's age should be permitted to participate in decisions such as this. The child should ultimately make the decision for himself. He is the one that would be experiencing the pain of chemotherapy, loss of ability to talk, walk, use his hands, and control his excretory functions. It is completely understandable that the parents do not want to see their son suffering, and would have a difficult time coming to terms with his decision. In the oncologists case, they should leave the decision up to the family and respect their wishes. They might advise the family on what might happen if they chose either way, but in the end, it is the family's choice.
ReplyDeleteConsidering Jimmy’s terminal condition and his understanding/knowledge of the suffering he’ll endure due both to the lymphoma and the incurable neurological condition I believe Jimmy should be involved in his care choices and have the right to make his opinion known to his care provider and his family so they know his wishes. However, due to his age Jimmy’s parents’ choice about treatment will be the deciding factor.
ReplyDeleteBecause of Jimmy’s minor status the parent’s decision about what care Jimmy will receive is decisive. This is important because it protects their right to make choices about their children‘s well-being as long as it is not harmful to the child.
This would be a complex situation for any health care provider to approach. However referral to counseling, possibly even a grief counselor because even though their son is still living they are dealing with the very harsh reality of his mortality, may help them see Jimmy’s point of view on the treatments and his wish to stop fighting. Furthermore, the parents need to understand the effects that putting their son through this treatment may have on him and the probability of success in a case like Jimmy’s. If the parents still disagree with or ignore their son’s wishes then the oncologist would have to proceed with chemotherapy because it still is their right to give consent to treatment.
I believe that minors should be permitted to participate in decisions of this magnitude. It is their life to live, why shouldn't they be aloud to participate in this type of decision? I do not think that Jimmy's decision should be the final decisive decision, but I also believe that the oncologist should not decide fully on what the parents think either. Jimmy is not going to have a normal life, his parents should understand that even if the treatment is successful he only has an expansion of months to his life. In those months, his neurological disorder could worsen and he could become wheel-chair bound and not able to talk or make decisions for himself at that time. This is a better time for him to make a decision because of that situation. If Jimmy is able to have such a strong connection with God at such a young age, his thoughts and views about his life should be taken into consideration by the physician. I think the doctor should gather a counsler and chaplain to discuss this situation with both parents and Jimmy together. Jimmy needs to be able to discuss with his parents about his decision and the parents need to be able to discuss their views and reasoning for their decisions. Support from the counsler and chaplain can help both parties get through the situation together. The oncologist should talk to the parents about Chemotherapy and the complications from therapy and how harsh it can be on one's body. The oncologist should also explain that Jimmy will only live for months longer and might be in significant pain if they decide to go with the treatment and is it extends his life for those couple of months. Jimmy is young, but any situation like this should always include the patient. They are the one that will have to live their life, no one should make such a strong and hard decision for them.
ReplyDeleteI know that parents always want to do the best for their children, but sometimes I feel like they are blinded by their own wishes. If I was Jimmy, which I thank God everyday for blessing me with good health, I could not imagine being forced to go through chemo. The side effects of the treatment will most likely not be worth the extra three to six months of life that in which Jimmy could possibly lose more bodily functions due to his neurological disease. I agree with Camille and Marion in that fact that 11 is probably too young to be mental competent to make the decision. However, their input on the subject should be taken seriously.
ReplyDeleteThe case is difficult because many do not see an 11 year old capable of making the decision to live or die. I very much agree with Marion that if a child is seen capable by a psychiatrist, the decision should be theirs to make. If Jimmy is seen as mature child, who with his strong faith in God, fully understands the outcome of his decision, then it should not be up to the parents to decide for him. We talked in class a little bit about letting go of your loved ones. The parents in this situation are not ready to let go, but rather prefer their child undergo treatment that is only 20% effective and live a very painful life. If the child is ready to let go, the parents should also prepare themselves to go.
ReplyDeleteThe oncologist, although put in a hard situation, must respect the final word of the parents to abide by laws. I feel that the oncologist needs to make sure the parents fully understand the outcomes and circumstances that their child will endure. The chemotherapy may temporarily increase his lifespan, but his neurological disease will still progress decreasing his quality of life. Jimmy would no longer be capable of doing the childhood things they picture their child doing after recovery because he will be unable to walk, talk, and use the hands effectively. The oncologist should offer the parents other resources to talk to and give time for them to communicate thoroughly with their child before beginning treatment if the parents still override Jimmy's decision.
I do believe that minors should be permitted to participate in decisions of this magnitude. Jimmy and other minors like him will be in situations where a disease will take their body, and in the process, cause THEM pain. It would be selfish of everyone in the decision-making process if they did not at least consider Jimmy’s choice because nobody else in the Patient-family-doctor-nurse- relationship is feeling Jimmy’s PHYSICAL pain.
ReplyDeleteWhether or not the child should make the choice to die or not is a little more complex. In a previous statement, I said that the parents and doctors should consider his choice, but Jimmy is 11. Eleven is awfully young to be making life-and- death decisions, so I believe that IF THE CHILD HAS A CHANCE OF LIVING LIFE, absolutely the parents should fight to prolong his life, but in the case of Jimmy, he will be dead in less than a year. Even if Jimmy did not die, his neurological problem would be so debilitating, that Jimmy would not be able to LIVE. Yes, his body will continue pump blood to his muscles, but Jimmy would not truly live a happy life. And to top off Jimmy’s pain of living 12 months, his parents won’t be able to help Jimmy’s condition at all. Knowing this, his parents would only encounter ever more increasing emotional distress in the 12 months Jimmy has to live. Nobody wins in this situation.
The fact that nobody wins is what the oncologist should see. Jimmy has no more than 12 months left to live, he will be debilitated from his declined neurological functioning, he will be in pain, and his parents will be an emotional wreck for 18 months compared to 12 months (just a random guess on grieving periods). Jimmy is in pain and nothing will make Jimmy live a happy life. The oncologist should realize that everyone loses if his life is prolonged and more pain is produced. For everyone. I personally believe that it would be in everyone’s best interest if Jimmy’s wishes were followed.
-I found this summary interesting:
Most ancient Greek thought about the nature of human life was governed by two fundamental assumptions and these are the basis of Aristotle's approach to the study of ethics:
• That human life is comprehensible only when conceived of as being directed toward some end or good, and that it can be interpreted by a categorization of ends and means. In the sense that human life is thought to contain an ideal element, most Greek moral philosophy, including Aristotle's, is idealistic. Since Aristotle's moral system is concerned with determining ultimate causes and ends it can also be considered teleological.
• That the end toward which all practical human activity is directed is definable in advance of its realization. This takes moral knowledge out of the realm of abstraction and speculation, and gives it great practical importance as a code for personal life and a guide for the organization and administration of the political state.
http://www.cliffsnotes.com/study_guide/literature/Ethics-Summary-Analysis-and-Original-Text-by-Chapter-Chapter-XIII-Psychological-Basis-of-Virtue.id-21,pageNum-41.html
i feel that Jimmy should get some say in what happens to him. It is his life, but I do not feel an 11 year old can make such huge decisions with out guidance. I feel for his parents, but I do believe that He should get some say in his treatment. I would personally send them to counselling to work through there different opinions to come to an understanding. I think the oncologist should work with the family for counseling and grieving. The boy seems to understand his situation well, but I think his intentions and reasoning for why he doesn't want to fight should be asked. He's very young to be so ready for death. Maybe someone needs to take time to talk to him about what he is feeling. I wouldn't want my son to feel that ready for death at such a young age.
ReplyDeleteI feel that, even though he is only a minor, Jimmy should have a say in his cancer treatment. Due to his neurological disorder, he has already dealt with more medically than most of his peers. This makes him more qualified than most 11-year-olds to make a decision of whether to utilize chemotherapy.
ReplyDeleteIf Jimmy were only facing lymphoma, his parents would be more justified in wanting to do everything possible to attempt to cure the cancer. However, both Jimmy and his parents have been aware for some time that he will not survive to adulthood, and if he does, he will be largely incapacitated and incapable of living a "normal" or pain-free life. Because he is facing death regardless of whether or not he receives chemo treatments, I think he should have a say in whether or not to attempt to fight the cancer.
The parents will have the final decision for legal reasons. However, I feel they should listen to Jimmy and hear what he has to say before making a choice. As a parent, I cannot imagine making this decision. But forcing their son to deal with the discomforts of chemotherapy against his wishes does not seem to be the way to go, especially with the grim prognosis.
Jimmy's parents had been preparing to face his death since before his cancer diagnosis. They knew they would likely outlive their son, and I can understand why they would want to have as much time with him as possible. But in my opinion, watching their child suffer silently, unable to communicate, move, or even relieve himself properly is not doing him any kindness. His parents need to look at the situation from Jimmy's perspective before putting him through painful (and likely unsuccessful) chemotherapy treatments.
The oncologist has a responsibility to both parties. She needs to listen to Jimmy's wishes and to hear his reasons for declining chemo. She will ultimately have to obey his parents' wishes, though, so she needs to understand exactly what they are saying, too. The oncologist also has a responsibility to help communicate the pros and cons of each decision to both Jimmy and his parents. If she is able to provide them with all of the facts, hopefully they will be able to come to an understanding.
Even though Jimmy is only 11, he seems to understand the situation he is in if he does the chemo treatments to help with his lymphoma and also how he is going to only live to 18 years old with his neurological disease. I think he and other minors should be able to participate in decisions like this because they are only participating, not overriding their parents' decision. I don't think 11 years old is too young to make a decision like that, for example because Jimmy has already accepted dying at a young age which is hard thing to do at 11. So, I think kids that age can handle a decision like that. Parents' should listen to the child's thoughts on the decision and factor them into the final decision because it is the child that is going to be going through all the treatments along with the horrible side effects, not the parents. However, the parents' decision should be decisive because the child is still only a minor, so the doctor would have to listen to what the parents decide. Maybe there could be a law created to where the parents had to factor in what the child wants into the final decision. The oncologist could probably understand where the Jimmy is coming from, and I think she should fight for Jimmy because as Jimmy's doctor she is supposed to fight for the wishes of her patient. She should try to convince Jimmy's parents where he is coming from, but also sympathetic with the parents because it truly is hard to lose a child at such a young age. Someone just needs to be there to help the parents get through this situation and help them understand that Jimmy doesn't want to go through all that pain.
ReplyDeleteThis case is a tough to decide on who is right and what should be done. I think personally that if this was a patient of mine I would fight for what Jimmy wants because he is the one that would have to go through all the chemo and the bad side effects. Who knows he might die from a complication from one of the side effects from the chemotherapy. I just hope that even though Jimmy's parents are going through a tough time they can understand where he is coming from and accept like he has the fate that God has given him. With God, they will be able to make it through anything.
In my belief, minors of Jimmy's age should be permitted to participate in decisions of refusing treatment. I feel that it should be up to the child to decide whether they want a life with or without terrible side effects that could come with treatment. That is only giving the child about the same time that has already been indicated by the oncologist without treatment. Shouldn't Jimmy's quality of life be considered??
ReplyDeleteGilbert Meilaender is recorded saying, "Life is not our God, but a gift of God; a death is a great evil, but not the ultimate evil. There may come a time, then, when it is proper to acknowledge death and cease to oppose it. Our aim in such circumstances is to care for the dying person as best we can - which now, we judge, means withdrawing rather than imposing treatment."
As for the oncologist, i would agree with Melissa and recommend the parents, as well as, the child to go to a counselor. The counselor then could help the family move toward a final decision, in which, is best for the child, seeing that the child will be enduring the illness and possible treatment that could put him in even more pain.
Decisions of minors should be assessed to make sure that they fully understand what is going on and what their options are. If the child can fully understand the situation it should be the child's decision. Granted most children at that age know would probably know what is going on, but they may not completely understand. The oncologist should sit down with Jimmy and his parents and talk with them about the situation, or allow the family some alone time to really discuss it with themselves.
ReplyDeleteJimmy seems to understand his situation, as he has accepted everything. I think his parents should sit down and tell Jimmy how they feel about his decision and he should explain to them how he feels. I don't think it's right for his parents just to step in and make this decision for him. Even though he is 11 years old, I think that given the situation he would be able to make a mature decision. If I were in his place I would want my parents to respect my wish. On the other hand I am not religious and I would want to undergo the chemo for my family. I know they would want me to and I'm very close to them so I'd want as much time with them as possible even if it put me through pain. This may be due to the fact that I would also not be ready to leave them at such a young age, and it would hurt me more to see them hurt than for me to experience pain to myself.
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ReplyDeleteI believe that minors of Jimmy's age should be allowed to participate in decisions of this magnitude. If the child understands the illness and treatment then he should be allowed to participate. After all in the end it is his life and he is the one who is going to be living it. It is hard when a loved makes a decision about a life and death situation that the family does not agree with. It is also selfish for the other parties to ignore that patient's participation in his or her life. I do not think that Jimmy should make the final decision, but the parents need to understand that the treatment will only keep Jimmy living for a few more months. Also those months may not be worth living for Jimmy especially if his neurological disease progresses. I think the parents need to make sure they are thinking about Jimmy and his needs to make this final decision. I think the oncologist should follow what the parents decide due to abiding by the law but he or she needs to sit down with the parents alone and discuss their son's health conditions. This situation is even harder to deal with because it is a child who is sick. I think people need to understand that children are capable in participating in these types of decisions and their wishes should not be overridden just because they are at a younger age.
ReplyDeleteI believe that Jimmy should be able to make the decision for himself. He is the one who will have to go through all the pain. The doctors have told him that he will die and cannot be cured. He has been through a lot and is so young. I feel he is mature enough to decide. He is religious and knows that he will be with God. I can understand why a parent would want to keep the child alive, it is their baby boy. But he will be in so much pain with the chemo. I think, if I was in Jimmy’s position, I would rather pass away, and enjoy what little life I had left.
ReplyDeleteThis is a very tough scenario. Personally, I believe that minors of Jimmy's age should be allowed to participate in these kind of decision making situations, too! I'm trying to put my self in Jimmy's shoes and it is so hard to take in and comprehend the medical situation he was going through. He is the one bearing a serious magnitude of pain, besides all the medical assistance that might be offered to him. Jimmy's situation is so hard because he was suffering from two deadly diseases, and one of them being incurable.
ReplyDeleteSince it is Jimmy who goes through the pain and agony, his decision should be taken into consideration. Parents will forever try as much as they can to help alleviate the situation. However, when the parents' decision is finally used as the verdict, by doing this they shall have gone against the will of their son, Jimmy in this case! This does not imply that Jimmy's parents should not play a role in the decision making and have hope, but putting into consideration and weighing the chances of Jimmy living (with regard to the diseases that befell him).
The oncologist is in a tough decision making situation as well. She 'indicated that the chemotherapy provides an effective cure to 20% of cases like Jimmy's'. the oncologist should therefore try persuade Jimmy into believing this and give it a try....but if the patient does not agree completely, then doing that against his will and consent will be a very big mistake done! I think the oncologist should talk to Jimmy in the presence of his parents vividly elucidating the great chances of him living longer by undergoing through the chemotherapy. Besides, she should also bring up the religious discussion that he has faith in God and that all the medical attention that will be pursued should help too at the end of the day! Overall, I think if both the oncologist and Jimmy's parents accept Jimmy's wish and will, it would not mean that they have given up on him, instead it is being respectful to their child's will and decision. Otherwise, this was a serious and tough situation that the parents, oncologist and Jimmy had to go through! Situations like this happen across the world, and it is so terrifying if not only saddening.
I believe that everyone has a decision in critical times even if you are the same age as Jimmy.Everonye has a freedom of speech and equal opprotuinity to voice their opinion. When you have someting as severe as Jimmy's condition, I think it is right to have the minors say even if it is the parent's who make the final decision. This way, the parents or guardians know the wishes of the minor and shouldn't feel guilty for what the outcome may be.
ReplyDeleteI think that both Jimmy and his parents have a equal decision about his situation. Even if Jimmy's decision is overridden by the parents, he at least will be able to know he told them what he wanted to do. In the case Jimmy knew he was aware of the situation and that even without lymphoma he may not have lived till 18. Overall, it is the parents final decision because the are liable for Jimmy and have the right of him.
With any doctor they should always hear both sides of the story. The oncologist should sit down and hear Jimmy's requests about getting treatment and also the parents. It shouldn't matter if Jimmy is a minor or not because in the end you know why he would have wanted. I know it could be hard for the oncologist emotionally, but with him/her knowing the situation, it will be easier to make a final decision and support the decisions of Jimmy and his family.
It would be hard if i was the parents in this situation because I would feel guilty not trying to help save my child's life or postpone it. It would be very emotional because you know as a parent you have the last say. I would feel better knowing that Jimmy is close to God and knows the outcome and isn't afraid. The parents should be happy that with the religious belief in the family that Jimmy is at peace and is not scared for what may come. This case is very hard for everyone and would still be hard even if Jimmy wasn't a minor. It would then be Jimmy's decision to weather or not he wanted to have treatment and the parents voice would want to be heard then .
I believe that although Jimmy may not be fully capable of making the decision on his own, he can take part in it. After all it is his life, but I do understand that he is only eleven years old and may not be able to fully comprehend his situation. Then again many children that are put with these situations can grow up fast. His parents also have a big part in the decision. I think the best situation would be if Jimmy and his parents could sit down and talk about the decision. Maybe after they talked the parents would understand where Jimmy is coming from and vice versa. Since Jimmy is a minor, I still believe his parents should play a bigger part in the final decision. I also believe that before they make the decision they need to consult Jimmy. If the oncologist knows that Jimmy and his parents' views are conflicting, maybe he could sit down and talk with both of them. The doctor and a psychologist could maybe explain to them all the details in either situation. No matter what the decision the parents make, I still believe they need to take in account and at least listen to Jimmy's opinion.
ReplyDeleteThis is a very unfortunate situation, but an extremely realistic one as well. Pediatric oncology is nothing short of upsetting, but as nurses we must face the fact that we will see this at one point or another if we haven’t encountered it in our personal lives already. While the parents of this situation do not want to live their life without their son, Jimmy, he should definitely be able to participate in the decisions that are made about his life. However, with him being only 11 years old, it would be difficult to leave the decision solely up to him. If the parents were to make the final decision, I believe the oncologist should advise them to also take their son’s wishes into major consideration. It is his life, and if he is accepting of his death and ready to be with God, then the parents need to begin the accepting process as well. While the chemotherapy might extend Jimmy’s life by a few months, what kind of few months will that be for Jimmy? Surely it would be months of more pain and suffering with the same outcome as if he did not receive the treatment at all.
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ReplyDeleteI agree with many of these post. I think that Jimmy has the right to decide what he wants for himself. I know this is a young age, but if he believes that it is the right thing for himself and that he is ready to go to God then he shall. I don't think it is a young age to decide what hey needs for himself. I know that the parents don't want to lose their child at a young age, but life throws us a curve ball and we have to handle the situation no matter if we don't want to.
ReplyDeleteThe way the oncologist should handle the situation would be to talk to both the parents and Jimmy because since he is a minor they should have to finalize on one thing, but I believe that Jimmy has the right to what he wants for himself. The parents need to accept what is happening in their life and enjoy the final days that they do have with their son.
As most of my classmates have said, Jimmy should absolutely be involved in the decision making process. Even if he was not involved and they continued with treatment, if a pt does not want to participate they will be less likely to benefit.
ReplyDeleteIn Jimmy's case, he is probably beyond the emotional maturity of a typical 11 year old, for this reason, a psych consult should be acquired to determine his understanding and knowledge of the situation.
MD's cannot forget that underneath the disease there is a pt, regardless of his age, he has a right to understand and at least assist in the decision making process.
The oncologist should assist the pt by helping him to understand, but also, helping the parents to understand the risks and benefits and the reasons why their child feels this way. Ultimately, Jimmy's opinion should play a big role in the decision making process, but I feel a psychologist, case worker, and oncologist specializing in pediatric cases should be consulted.
I also believe that Jimmy should have a chance to give input about his treatment. I agree with Katie's point that Jimmy's maturity level is probably a lot higher than that of a typical 11 year old. He has obviously been through a lot in his short life, but he has comfort in knowing that he is going to go to God.
ReplyDeleteI understand the parents' need to keep Jimmy around as long as possible. However, do they want to see Jimmy be useless and sick all of the time? I don't think I would want to see that from my child. If he is ready to let God have His will, then the parents should support their son. I agree with many that he should not be the only one making the decision, but I think Jimmy's input should have a large impact on the decision being made.
In this case, I believe Jimmy should be able to make his own decisions on his own life. He is fully competant and knows what the future holds for him. I dont think Jimmy should give up because a prognosis is just that, it is not definate, but I'm presuming Jimmy has already been through a lot and may not be able to handle much more. Based on Jimmy's prognosis I believe his decision should be taken not his parents. I feel that they are just being selfish. If Jimmy wanted purposefully to die then the parent's decision could be taken. The oncologist should inform the parents of all options and suggest to follow Jimmy's decsion but in legal matters he has to follow what the parent's decide.
ReplyDeleteI believe Jimmy should be able to make this decision, because of him going through the situation he knows the ends and outs of it all and he knows he doesnt want to put himself in that state and put his parents in that position. Any one at his age if they know the situation, consquences, etc. should be able to make the decision themselves because it is their life in the end and it doesnt belong to anyone else. The doctor should look at all sides assess his feelings to and see if he would be able to go through with either decision.
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