Refusal of treatment: a new dilemma for oncologists

Thirteen cases of childhood malignancy are described in which treatment was refused. Four groups are presented: 1) the parents refused treatment for a child with a good prognosis, 2) parents refused treatment for a child with a poor prognosis, 2) the patients refused treatment, and 4) child abuse or neglect occurred in conjunction with refusal of treatment. Parents refused treatment on the basis of religious grounds, seeking unproven methods of treatment, a conviction that treatment was worthless, or a feeling that treatment of the child interfered with the parents' life-style. Children refused treatment because they did not like the therapy side effects, did not like painful procedures, or felt the disease was hopeless. Some families refused treatment at one point, then later asked to resume treatment. Management of these cases depends, to a great extent, on prognosis. Those children having a good prognosis can be called to the attention of the juvenile court on the basis of medical neglect. In children with a poor prognosis, recourse to the juvenile court is not indicated. In all cases, frequent communication with the families is extremely important even when treatment has been refused.