I've recently encountered a bit of an ethical dilemma at work. For the first time, I had to float on a pediatric oncology ward, and I read in the chart history of one of my patients that the nursing and medical staff had to deal with her parents asking them not to reveal the diagnosis of leukemia to their daughter.
How it was resolved was not clear in the notes, and I did not have time to read the entire history.
It occurred to me to come on the forum and ask: what would you have done? Here in Canada, the age of a child is until 16. This patient was 9. Putting the logistics of the daughter already being on a cancer ward and surrounded by other children with cancer aside, how would you deal with this request?
Obviously, we need to advocate for the daughter, and gently remind the parents that children are very perceptive and generally immediately know when there is something wrong. But if they were adamant?
I work in a children's hospital and they might let a parent go a few days without telling the child, but not forever. Especially in cancer, there is so much those kids have to go through for treatment, they have to know what is going on and own their disease.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Although every case is different, I've found that children (including my own little bro) don't conceptualize thoughts of life and death anything like adults do, and that most probably they are projecting their fears and adult grasp of the situation onto their 9 year old child. Children are first very "here and now" and second, they relate to other children diagnosed with similar illnesses and bond with them in a unique and supportive way. By not being honest with their child, they leave his or her little radar with incomplete information and block the ability to understand and bond with their peers.
I would never tell the child anything like that without involving the parents. What I would do is work with (or have social workers/child life specialists) work with the parents first and foremost to find out what they are trying to spare their child by withholding that information, I'd try to hook them up with parent support groups if they are not being treated at a large oncology center, as that would likely allay their fears that their child will fall apart psychologically upon hearing "leukemia" or "cancer".
It really takes an expert to understand the family dynamics before an intervention such as providing the child with information the parents feel very strongly against being shared. They will be spending many grueling hours in hospitals and clinics - the family has to be seen as a unit for the best possible outcome for the sick kiddo.
Specializes in mental health, aged care/disability care.
My son was told when he had leukaemia, but he was only 5 at the time and has Down Syndrome so he didn't totally understand.
Personally I think the child should be told because they are going to know they have cancer anyway as soon as their hair starts to fall out. Most kids of 9 would understand that.
This should be up to the parents not the patient's nurse. We are not in the business of telling parents how to break news to their children. This is a request that should be respected. I can tell you from many experiences like this that ethics will take the parents side on this one.
I've recently encountered a bit of an ethical dilemma at work. For the first time, I had to float on a pediatric oncology ward, and I read in the chart history of one of my patients that the nursing and medical staff had to deal with her parents asking them not to reveal the diagnosis of leukemia to their daughter.
How it was resolved was not clear in the notes, and I did not have time to read the entire history.
It occurred to me to come on the forum and ask: what would you have done? Here in Canada, the age of a child is until 16. This patient was 9. Putting the logistics of the daughter already being on a cancer ward and surrounded by other children with cancer aside, how would you deal with this request?
Obviously, we need to advocate for the daughter, and gently remind the parents that children are very perceptive and generally immediately know when there is something wrong. But if they were adamant?
Thank you in advance for any responses.:redbeathe
In our facility, nurses don't have to worry about this at all.
Mainly because it's our policy that all dx given to patients are given by the physicians, not the nurses, in case there are questions.
To me, the parents need to be able to process/accept the dx before the child is told so they can be appropriately supportive.
I also support the parents not telling the child if they want a second opinion...no matter how "sure" the original physician is of the dx.
However, if that is the case with one particular child, then that should be PRIORITY information that gets passed on in report that the child doesn't know yet.
If it gets to the point that the child's health takes a major turn for the worst...to me, that is when ethics should come in, because even a child deserves to know if they are dying...I would only get involved if it got that far and only if the physician refuses to address the issue with the parents.
I work in a children's hospital and they might let a parent go a few days without telling the child, but not forever. Especially in cancer, there is so much those kids have to go through for treatment, they have to know what is going on and own their disease.
I find this shocking...no physician, nurse, hospital social worker, etc, should have the right to tell ANY parent on how long they have to break the news to the child.
What do they mean, "They won't let them go on for more than few days"?????
Apparently, someone in the hospital has very little compassion for a family going through a major life crisis to where they might lose a child.
To me, the hospital has no right to dictate such decisions...no right whatsoever.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I find this shocking...no physician, nurse, hospital social worker, etc, should have the right to tell ANY parent on how long they have to break the news to the child.
What do they mean, "They won't let them go on for more than few days"?????
Apparently, someone in the hospital has very little compassion for a family going through a major life crisis to where they might lose a child.
To me, the hospital has no right to dictate such decisions...no right whatsoever.
I worked in a peds hospital, too. They would never have removed the child from earshot of the parents to tell them something like that against the wishes of the parents. If they tell the child, but not the parents, the child is likely to ask the parents questions about their health, and the parents won't know what the answer is - making for a more anxious and fearful child. The parents are going to be responsible for making sure the child returns day after day for chemo, for keeping on top of his or her blood counts, and medicating the child at home per protocol. If the hospital fractures their trust, they might bolt altogether. It takes no small amount of courage and commitment to endure allowing your child to undergo painful treatments and procedures.
Specializes in acute care med/surg, LTC, orthopedics.
And you can't ask someone if they want to know that they are very ill without telling them that they are ill. I think it is not something that is so cut and dried. There are cultural differences in the desire to know as well as individual preferences, and the importance placed on knowing is a bias itself. This situation is all the more complicated because the patient is a child. Aren't we taught that parents are the experts on their child?
I would argue this. Parents may believe they are acting in the best interest of the child but only if the child holds the same concept of morality, same philosophy of life, same religious implications etc. as the parents and this aspect can't be assumed just because the parents raised the child in an environment of shared belief systems. Take the Jehovah Witness parents who withhold blood transfusions from their dying child, is it right to assume the child would refuse this treatment based solely on the fact that the parents would?
As for parents being experts on their children... well, we've all dealt with those unfortunate souls who have no business polluting the gene pool with their stupidity so I would argue this statement isn't as absolute as it sounds.
I would argue this. Parents may believe they are acting in the best interest of the child but only if the child holds the same concept of morality, same philosophy of life, same religious implications etc. as the parents and this aspect can't be assumed just because the parents raised the child in an environment of shared belief systems. Take the Jehovah Witness parents who withhold blood transfusions from their dying child, is it right to assume the child would refuse this treatment based solely on the fact that the parents would?
In this situation, don't you need a court order to be able to treat the child against the parent's wishes? The parents aren't overruled lightly in this case- why would they be when it's not an issue of withholding treatment but of how and when the child is informed of the diagnosis.
As for parents being experts on their children... well, we've all dealt with those unfortunate souls who have no business polluting the gene pool with their stupidity so I would argue this statement isn't as absolute as it sounds.
No, it's not absolute. And neither is it absolute that knowledge of one's condition is always desired, NOR that as healthcare providers, WE are the ones who know best. If there's a conflict between what the parents vs the healthcare providers believe is best for the child, that needs to be mediated thoughtfully and individually, not simply overruled.
Parents might need some time to deal with the devastating news, decide on how to tell the child, get a second opinion, etc. I would honor their request. I do however think if the child needs chemo and/or an extended hospital stay they need to be told why hair will fall out, why they will be in hospital, etc. It would be grossly unfair for a child to be losing their hair and scared out of their mind without some facts as to what is going on and why. Parents are also scared out of their minds when confronted with such horrible news so open communication and support for the family is a must. With both these things in place we can guide and aide the parents through this difficult time and be a comfort for all involved. I can only imagine their fear and pain.
Annaiya, NP
555 Posts
I work in a children's hospital and they might let a parent go a few days without telling the child, but not forever. Especially in cancer, there is so much those kids have to go through for treatment, they have to know what is going on and own their disease.