The pain of watching children die!

The father of an 11-year-old Canadian boy with leukemia wants to stop his painful treatment. The doctors say No. Who’s right?

Decisions about medical treatment for critically ill children open up a world of competing sorrows. The case of the 11-year-old Canadian boy with leukemia, whose father refused a second round of chemotherapy for him, is no exception. The plight of the boy and his father has sparked a nation-wide debate.

The right of parents to decide on medical treatment for their children flows from a presumption that they will act in their children's "best interests". Parents have an obligation to provide their children with the necessities of life, which include the medical treatment needed to protect their lives and health. For a variety of reasons, however, parents can refuse treatment for their children that medical professionals and others regard as essential.

The right to refuse treatment for one's child is narrower than if the parents were deciding for themselves -- competent adults have an almost absolute right to refuse, which is much broader than what they can refuse for their child. It's been reported the young boy has also refused treatment. Whether that refusal is legally valid depends on his capacity to provide an informed refusal -- the flip side of an informed consent.

A valid informed consent or refusal requires the person to be competent and informed, and their decision voluntary. Competence is often in doubt with children's own treatment decisions. In judging competence, courts take into account the child's age, experience and intelligence; independence from their parents; and the reasons they give for refusing the treatment. Courts have increasingly found mature minors competent to decide about treatment, but that is highly unlikely with an 11-year-old. Ethically, however, the child's wishes should still be taken into account. When, as in this case, there is an irresolvable conflict about treatment between parents and doctors -- unless the situation is an emergency -- a court order is required.