Nonmaleficence Vs Beneficence In The Autonomy Of Adolescents

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The autonomy of adolescents is a difficult topic that healthcare professionals deal with daily. A minor, by definition, is a person younger than 18, while some children mature at an earlier age compared to their peers and might be able to make their own autonomous decisions, it is ultimately the discretion of the physician and/or the parent or guardian to make whether the minor is making an informed autonomous decision.

Maximillian is a 12-year-old boy suffering from malignant tumours on his brain and spinal cord who is refusing treatment due to anxieties regarding being too fatigued to play soccer on his school team. Maximillian’s parents have stated that they do not want to start treatment but want to place him on a vegan diet free of sugar and animal byproducts to allow his body to heal itself. Dr Jones who is the primary health practitioner on his case has stated multiple times that although the tumours are not life-threatening right now, she expects that they will be if they are left untreated. Radiation is the best treatment plan as of right now if radiation does not shrink the tumours Dr.Jones and Maximillian (and family) can further discuss more aggressive treatment options.

Biomedical Ethics focuses on the rights and obligations of healthcare providers and patients. It focuses on morality and theoretical and practical issues involved in the HCP and patient relationship. The four principles of biomedical ethics outlined are respect for autonomy, beneficence, nonmaleficence, and justice.

According to the four principles of biomedical ethics outlined in the textbook, it is unethical for Maximillian’s parents to refuse life-saving treatment for their son. The principle of autonomy states that the patient or the parents must be competent and rational to make a decision. They must have adequate information and understanding about the set of available option free from any coercion towards or away from one of the options. In Maximillians case his parents are not making an autonomous decision as they do not understand the consequences of not starting treatment. Operating under the assumption that Maximillian’s parents are not HCP, they cannot have an adequate understanding of medical procedures or lack thereof and their consequences. Another principle relevant to Maximillians case is Justice. Justice requires that health services are distributed fairly meaning that patients that have tumours receive the same care. If other patients are benefiting from radiation treatment, Maximillian is recommended to receive the same care. If the HCP does not start treatment they will not be practising Nonmaleficence as his long term health will decline and cause him to harm both emotionally and physically. The HCP will also not be practising beneficence as they will not be helping the patient.

As stated above Maximillians parents will be acting unethically if they refuse treatment as they are not making an autonomous decision. Knowing this Maximillian’s parents should not be allowed to decide for their son’s treatment plan. Although Maximillian’s personal treatment decision should be accounted for and discussed, Maximillian is too young and underdeveloped to make a life-altering decision therefore not competent and cannot provide informed consent. By limiting the patient-parent autonomy the HCP will be acting paternalism more specifically strong paternalism which allows the HCP to override their decision to promote nonmaleficence and beneficence. In conclusion to meet the four principles of biomedical ethics outlined in the textbook and to promote overall nonmaleficence and beneficence for both the patient and family, the parents of Maximillian should not be able to make medical decisions for their son. 

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