When is treatment refusal medical neglect?: Ethical considerations contextualized to pediatric oncology

Pediatric oncologists struggle to determine whether specific scenarios of treatment refusal raise to the definition of medical neglect. Ethics services often receive consultations about treatment refusals in childhood cancer due to the moral distress raised by these concerns. With training, pediatric cancer clinicians may have an improved ability to manage these scenarios via humility, curiosity, and a consistent, contextually grounded application of ethics principles. This Discussion Article applies key contextual considerations (prognosis, parental reasons, etc.) to a common ethics question regarding the refusal of childhood cancer treatment. A traditional approach in ethics practice is to a priori apply ethics principles as the first and foundational framework for analyses. We believe the multi-layered and complex nature of treatment refusal scenarios benefit when contextual awareness is prioritized. This is a practical and relevant approach to engaging in the highly challenging, often charged circumstances of treatment refusal in childhood cancer. This approach pragmatically helps to decipher the potential harms and mitigating factors relevant to treatment refusals while maintaining the child as central.