[Paradoxes in the judicial institution concerning decision-making in pediatric oncology].
In paediatric oncology, the medical decision-making process is characterized by the importance of what is at stake: the vital prognosis. Refusal of care, or, more specifically, refusal of a treatment, always appears "at the crossroads of multiple stakes... implicating an entourage [family members], a medical team, and rules of law that sometimes give rise to contradictory interpretations". Paradoxes in the judicial institution are evident on two levels: i) in the values established by the law; where adults are concerned, the law explicitly refuses to consider the biological survival of an individual as the supreme value; it gives priority to respect of the patient's wishes and his or her autonomy; for children, in contrast, the supreme value established by the law is biological survival; the physician must provide the care indispensable to protect the health of a minor at all cost; ii) between legal texts and jurisprudence; while the law authorizes a physician to override the parental authority when he judges a treatment necessary to protect the health of a minor, jurisprudence in pediatric oncology has always declined to define the best therapeutic strategy where a child's chances of survival are concerned.
Sirvent
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Service de Pédiatrie, CHU de Nice, Hôpital Archet 2, 151 Avenue de Saint Antoine Ginestière, Nice cedex 3, France. sirvent.n@chu-nice.fr
D000328:Adult; D002648:Child; D003657:Decision Making; D005602:France; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D009369:Neoplasms / Q000628:therapy*; D033282:Parental Consent / Q000331:legislation & jurisprudence; D010358:Patient Participation; D028701:Patient Rights / Q000331:legislation & jurisprudence; D026684:Personal Autonomy; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*