Attitudes of adolescent cancer survivors toward end-of-life decisions for minors.
OBJECTIVE
The present study aimed to investigate the attitudes of adolescent cancer survivors toward end-of-life decisions with life-shortening effects, including nontreatment decisions (NTDs), intensified alleviation of pain and symptoms (APS), and euthanasia, and the influence of illness experience on these attitudes.


METHODS
Adolescent cancer survivors were interviewed with a structured questionnaire using hypothetical case descriptions. The results were compared with a study of 1769 adolescents without experience of chronic illness.


RESULTS
Eighty-three adolescents, 11 to 18 years of age, were interviewed. In terminal situations, 70% to 90% found requests for NTDs acceptable, 84% requests for APS, and 57% to 64% requests for euthanasia. Requests for end-of-life decisions were less acceptable in nonterminal situations, where 28% found requests for NTDs acceptable, 39% to 47% requests for APS, and 11% to 21% requests for euthanasia. Frequently cited reasons for holding back physicians from administering a lethal drug to a child were the child not being well informed about his or her condition (92%) and the parents' opinion not being asked (92%). Compared with adolescents without experience with chronic illness, cancer survivors were more accepting toward requests for NTDs and APS in terminal situations.


CONCLUSIONS
Adolescent cancer survivors, like other adolescents, want to be involved in medical decision-making at the end of life. They value autonomous decision-making, without excluding parents from the process. The experience of living through a life-threatening illness can alter adolescents' attitudes toward requests for NTDs and APS.
Pousset
Geert
G
Bioethics Institute Ghent, Ghent University Hospital, Ghent University, Ghent, Belgium. geert.pousset@ugent.be
Bilsen
Johan
J
De Wilde
Joke
J
Benoit
Yves
Y
Verlooy
Joris
J
Bomans
An
A
Deliens
Luc
L
Mortier
Freddy
F
D000293:Adolescent; D016223:Advance Directives; D001293:Attitude to Death; D002648:Child; D003657:Decision Making; D005065:Euthanasia / Q000523:psychology; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology; D007406:Interview, Psychological; D008297:Male; D033242:Minors / Q000523:psychology*; D009369:Neoplasms / Q000523:psychology*; D009426:Netherlands; D010166:Palliative Care / Q000523:psychology; D012297:Right to Die; D012803:Sick Role; D017236:Suicide, Assisted / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology; D014342:Truth Disclosure