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Telling the Truth to Child Cancer Patients in COVID-19 Times
Lynn Gillam1,2, Merle Spriggs3,4,5, Clare Delany3,6,7
1Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia. Lynn.gillam@rch.org.au.
Insights
Children with cancer undergoing bone marrow transplant (BMT) may face sustained health effects from COVID-19. Ethical guidance suggests informing them about treatment changes they will experience, but not risks unless they inquire.
Area of Science:
- Pediatric Oncology
- Bioethics
- Infectious Diseases
Background:
- COVID-19 disproportionately affects adults, shifting ethical focus away from pediatric considerations.
- Children, while at lower risk for severe COVID-19, may experience significant long-term health and well-being impacts.
- Pediatric cancer care, particularly bone marrow transplant (BMT), presents unique ethical challenges during the pandemic.
Purpose of the Study:
- To explore the potential physical, psychological, and emotional effects of COVID-19 on children undergoing BMT.
- To address the ethical dilemma of disclosing treatment modifications due to COVID-19 to pediatric cancer patients.
- To provide ethical recommendations on communicating information to children aged 5-12 regarding cancer treatment changes.
Main Methods:
- Literature review on COVID-19's impact on pediatric health and BMT.
- Ethical analysis drawing on established principles of truth-telling in pediatric care.
- Case study approach focusing on children with cancer undergoing BMT.
Main Results:
- COVID-19 can lead to sustained physical, psychological, and emotional challenges for pediatric BMT patients.
- Ethical frameworks support disclosing direct treatment modifications to children.
- Disclosure of increased risks should be contingent on the child's specific inquiries.
Conclusions:
- Children undergoing BMT require tailored communication strategies regarding COVID-19-related treatment changes.
- Prioritizing a child's direct experience and understanding is ethically paramount.
- Balancing transparency with age-appropriate disclosure is crucial in pediatric oncology ethics.
Abstract:
A notable feature of the COVID-19 pandemic is that children are less at risk of becoming infected or, if infected, less likely to become seriously unwell, so ethical discussions have consequently focused on the adult healthcare setting. However, despite a lower risk of children becoming acutely ill with COVID-19, there nevertheless may be significant and potentially sustained effects of COVID-19 on the physical, psychological, and emotional health and well-being of children. Focusing on the context of children's cancer care, and specifically bone marrow transplant (BMT), we describe some of these effects and then address one specific ethical challenge that arises. That is the question of what and how much to tell children whose cancer treatment has been changed because of COVID-19. Drawing on our previous work on the ethical reasons for telling the truth to younger children (aged 5-12) we link different ethical reasons to the different types of information that could be given to children in this context. We argue that children should be given an explanation of the changes that they will directly experience, including some changes to the process of their actual medical treatment; but not about increased risk associated with these changes, unless they specifically ask for this information.
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