English 1301-Writing Assignment and peer review for two classmates
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K ayla R ude
W . Scott C heney
EN G L 1301 W S6
15 N ovem ber 2014
W hose C hoice Is It?
I. D ialogue (W C : 380)
(D ialogue betw een parents, doctor, and a judge occurring at a C hildren’s H ospital)
M r. Snow : Sir, Jessica’s cancer is term inal. W e’ve know n this for a w hile now . A ll w e are doing
is putting her through m ore pain and agony if w e continue the chem otherapy.
D r. Freedm an: Judge W alker, w e can’t know for sure that Jessica isn’t going to get better. W e
need to give her every chance she can get.
M rs. Snow : Every round of chem o she receives, she gets w orse. Each tim e she begs us to stop.
She doesn’t w ant this anym ore. N o one w ants to give up on this, especially us. W e are her
parents, and I don’t know how I w ill be able to survive w ithout m y daughter. B ut I don’t know
how I w ill survive w atching m y daughter in pain each day, trying to save her from som ething
that is inevitable.
D r. Freedm an: H er results m ay not look great currently, but m ore rounds of chem o can give her
m ore tim e. Perhaps w e can give her another six m onths to live.
M r. Snow : A nd that tim e w ill be painful and m iserable. She has m ade it clear to us that she can’t
handle any m ore chem o. She has no real life w hen she is isolated in a hospital room suffering in
severe pain and vom iting m any tim es a day. I am pleading w ith you to please, please look at m y
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daughter! Look at w hat she is going through and listen to her pleas for help! She cannot continue
to suffer like this w hen she is going to die anyw ay.
M rs. Snow : W e have kept the treatm ent going for three years, and she hasn’t show n any
im provem ent in the last year. In fact, the cancer has w orsened. W e can’t im agine letting our
daughter go, but w e also can’t stand w atching her go through this and know ing she doesn’t w ant
this anym ore.
Judge W alker: I’m sorry, M r. and M rs. Snow . I cannot begin to im agine the pain that your
fam ily has had and continues to endure.“The base of the decisions to be m ade should be the
benefit and w ellbeing of the patient” (G uvercin). The question here is w hat is the benefit of
continuing treatm ent and w hat is the w ellbeing of the patient. I have reached a decision...
II. R esearch Paper (W C : 1170)
The D ecision G oes To...
W hen it com es to children and term inal illness, w hose decision should it be regarding the
w ithdraw al of treatm ent? The m edical team , the child, or the parents? M any believe that the
m edical team or even the court system should m ake decisions regarding controversial w ithdraw al
of treatm ent in children. O ftentim es it is believed that parents or the child lack the m edical
know ledge necessary to m ake lifeending decisions. W hile a m edical team has the education and
know ledge of the m edical condition, the quality of life issue m ay not be taken into consideration.
A team approach involving the m edical team , the patient, and the parents “recognizes that the
perspectives and inform ation provided by fam ilies, children, and young adults are im portant in
clinical decision m aking” (“Fam ilyC entered C are”). W hereas the team approach is vital to the
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decision m aking process, ultim ately, parents should be the sole representatives of their children
w hen it com es to m edical decisions.
C hildren aren’t alw ays capable of m aking lifealtering decisions, especially if that
lifealtering decision can lead to death. In fact, in 1979 a case w as presented to the Suprem e
C ourt regarding children’s rights w ith their m edical treatm ent. C hildren w ho w ere being treated
in G eorgia m ental health facilities filed a law suit because they w ere being “involuntarily treated
in G eorgia m ental health facilities,” and claim ed that it w as violating the due process clause of
the Fourteenth A m endm ent of The C onstitution of The U nited States. The Fourteenth
A m endm ent states “...nor shall any State deprive any person of life, liberty, or process, w ithout
due process of the law ” (“D ue Process C lause”). The Suprem e C ourt ruled that “children are not
entitled to m ake treatm ent decisions because m ost children, including adolescents, ‘sim ply are
not able to m ake sound judgm ents concerning m any decisions, including their need for m edical
care or treatm ent’” (C hildress). This case brings to surface the issue that children don’t have the
judgem ent or m aturity to m ake such significant decisions. O ftentim es, an adolescent is treated
for years w ith chem otherapy and radiation; their quality of life can becom e very poor because of
the side effects from the treatm ents. The quality of life m ay reach a point, com bined w ith the
treatm ent not w orking, w here the child does not have the desire to continue to suffer. To place
the responsibility of term inating treatm ent for a m edical condition is not w ithin the scope of the
child’s ability to discern all of the issues. H ow ever, should the child’s input be considered?
N obody know s better than the child w hat the treatm ent is doing to his or her body. C hildren are
fully aw are of the issues of quality of life and m ay no longer be able to do anything they love.
Involving the child in discussions regarding the continuation or w ithdraw al of treatm ent is a
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natural step in the decisionm aking process; how ever, the child should not have the final say in
w hether or not treatm ent continues.
W ithdraw ing the treatm ent of a child in the N eonatal Intensive C are U nit (N IC U ) is a
very difficult decision to m ake. Som e people believe that the decision should be up to the
physician because the decision is too burdensom e for a parent to m ake. H ow ever, the Journal of
M edical Ethics gives an exam ple w here this is not the case. R esearch w as conducted in Scotland
using interview s “w ith 176 m edical and nursing staff and w ith 108 parents of babies for w hom
there w as discussion of treatm ent w ithholding/w ithdraw al” in an attem pt to decide w ho should
be the final decision m aker of w ithdraw ing treatm ent of the sick baby (M cH affie). M ost of the
m edical professionals believed that the parents should be a part of the decision m aking process
but not necessarily the final decision m akers. They believed that the decision w ould be too m uch
of a burden for the parents to m ake and “though the parents recognized the m agnitude of the
decision, the m ajority nevertheless saw it as part of parental responsibility. O f those 56% (60
parents) w ho believed they did them selves decide, only one father said it had been too
burdensom e and even he thought it w as theoretically correct that parents should accept this
responsibility” (M cH affie). M edical professionals are there to share the treatm ent options and
adm inister those treatm ents, but w hen it com es to the final decision of w hether or not a child
needs to have the treatm ent w ithdraw n, it needs to solely be up to the parents.
U ltim ately, the parents are the next of kin and have the m ost interest in the care and
treatm ent of their child. Parents m ay seem to not alw ays have the child’s best interest at heart in
the eyes of som e physicians. W hile that som etim es m ay be true, parents “intuitively considered
that decisions about treatm ent lim itations w ere part of this duty and right” (M cH affie). In som e
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circum stances, religious beliefs of the parents m ay conflict w ith m edical treatm ent options.
Som e religions do not believe in blood transfusions, w hile others m ay believe that prayer is the
treatm ent for their child. The A m erican A cadem y of Pediatrics believes religion should not get in
the w ay of a child’s treatm ent and they think “physicians w ho believe that parental religious
convictions interfere w ith appropriate m edical care that is likely to prevent substantial harm or
suffering or death should request court authorization to override parental authority” (M ercurio).
B ut I believe that it is not up to the m edical team or the m edical institution to force treatm ent on
patients w ho have specific beliefs that m ay oppose certain treatm ent options. Parents know their
child and love their child w anting only w hat is best for them ; how ever, the parent m ust be
educated in the disease process and the treatm ent options to m ake an educated decision. The
parents have experienced the ups and dow ns of the child’s treatm ent and know firsthand the
experiences that their child has been through; therefore, they are in the best position to m ake the
final decision.
C hildren w ith significant m edical issues present an ethical issue regarding the term ination
of treatm ent. C hildren born w ith abnorm alities or extrem ely prem ature have issues w here quality
of life plays a significant part of the decisions of care. C hildren w ith cancer or other term inal
diseases m ay reach a point in treatm ent w here there is little chance of recovery, and again quality
of life becom es a factor. A n adolescent m ay w ant to m ake decisions regarding their care or the
w ithdraw al of their treatm ent. A m edical team has a clear advantage w ith the am ount of
know ledge regarding treatm ent options and past experience treating patients. The m edical team
should play a significant role in educating the parents of the child involved regarding all facets of
the treatm ent. U ltim ately, the parents should possess the right to m ake final decisions on the
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treatm ent of their child. W hile the decisions are difficult and heartw renching, “historically it has
been recognized that natural bonds of affection lead parents to act in the best interests of their
children” (D utkiew icz). Parents never w ant to let their children go but w hen it com es dow n to
m aking the decision about w ithdraw ing their child’s treatm ent, it should alw ays be the parents
that have the final w ord.
III. N ew s A rticle (W C : 393)
G overnm ent R ules O n T he Side O f Parents
W ritten B y: K ayla R ude
In a controversial case that has been closely w atched by citizens across the state, Judge
B en W alker has ruled in favor of the parents. This case has im plications across the state and
perhaps the country, as parents are challenging the decision of m edical professionals to force the
continuation of treatm ent for their daughter w ho is term inal.
A pproxim ately three years ago, Jessica Snow w as diagnosed w ith an advanced type of
bone disease. H er sym ptom s presented w hen she began to have pain in her right leg that
w orsened over a course of tim e. Physicians at C ity M edical C enter have adm inistered four
courses of chem otherapy and tw o rounds of radiation. W hile Jessica cannot have any further
radiation, the physicians w ould like to continue chem otherapy in hopes of prolonging her life for
another six m onths.
O ver a course of the m onthlong battle, Jessica’s parents have advocated for their
daughter arguing that her quality of life should be a factor in w hether to continue treatm ent. To
further their case, Jessica is 15 years old and has adam antly stated that she w ants treatm ent
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term inated. B oth Jessica and her parents w ant her final w eeks or m onths to be spent outside of
the hospital doing the things that she dream s of doing.
In his ruling, Judge W alker discussed “parents [m ay] have a legal duty to provide needed
m edical care to their children” (W oods). W alker goes on to state that:
w ithout question, I believe that both the m edical team and the parents believe that they
are fighting for the bestinterest of Jessica. W hile the goal of treatm ent is to lessen or
ideally cure the cancer, the treatm ent is sim ply not w orking. There have been four other
failed attem pts at chem otherapy and rounds of radiation have not been successful.
Should Jessica be forced to receive treatm ent that she does not w ant, and is not helping?
M y decision is to allow the parents to m ake the final decision. U ltim ately, as her parents,
they have her best interest at heart and should have the final authority as her next of kin
w hether to continue or term inate treatm ent. A lthough I have struggled w ith this decision,
quality of life m ust be considered w hen treatm ent options are presented (R ude).
The hospital w ill not appeal the decision m ade by Judge W alker. The parents have asked for
privacy as they m ake decisions on how to m ove forw ard after the ruling.
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W orks C ited
B oyle, R . J., R . Salter, and M . W . A rnander. "Ethics of R efusing Parental R equests to W ithhold
or W ithdraw Treatm ent from Their Prem ature B aby." Journal O f M edical Ethics 30.4
(2004): 40209. JSTO R. W eb. 3 D ec. 2014.
C hildress, C harles G . "The R ights O f C hildren R egarding M edical Treatm ent." G PSO LO .
A m erican B ar A ssociation, A pr. 2008. W eb. 3 D ec. 2014.
"D ue Process C lause." G uide to the C onstitution. The H eritage G uide to The C onstitution, n.d.
W eb. 03 D ec. 2014.
D utkiew icz, Thom as. "C hild Protective Services and The Juvenile Justice System ." K now Your
Fam ily Rights. Fam ilyV s.State.org, 21 Feb. 2004. W eb. 03 D ec. 2014.
"Fam ilyC entered C are and the Pediatrician's R ole." Fam ilyC entered C are and the
Pediatrician's Role. O fficial Journal of The A m erican A cadem y of Pediatrics, 1 Sept.
2003. W eb. 03 D ec. 2014.
G oldstein, Joseph. "M edical C are for the C hild at R isk: O n State Supervention of Parental
A utonom y." The Yale Law Review 86.4 (1997): 64570. JSTO R. W eb. 3 D ec. 2014.
G uvercin, C em al H useyin, and B erna A rda. "Parents R efusing Treatm ent O f The C hild: A
D iscussion A bout C hild’S H ealth R ight A nd Parental Paternalism ." C linical Ethics
8.2/3 (2013): 5260. EBSC O host. W eb. 3 D ec. 2014.
M cH affie, H azel E. "D eciding for Im perilled N ew borns: M edical A uthority or Parental
A utonom y?" Journal O f M edical Ethics 27.2 (2001): 10409. JSTO R. W eb. 3 D ec.
2014.
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M ercurio, M ark R . "A m erican A cadem y of Pediatrics Policy Statem ents on B ioethics."
Pediatrics In Review 29.1 (2008): n. pag. Am erican Academ y of Pediatrics Policy
Statem ents on Bioethics. Pediatrics In R eview , 1 Jan. 2008. W eb. 03 D ec. 2014.
W oods, M ichael. "O verriding Parental D ecision to W ithhold Treatm ent." Am erican M edical
Association Journal of Ethics 5.8 (2003): n. pag. VM . A ug. 2003. W eb. 03 D ec. 2014.
