Parental Refusal of Life-Saving Treatment: Resolving an Ethical Dilemma


This paper aims to resolve an ethical dilemma involved in the case of Alexa, an 11-year-old girl undergoing chemotherapy for acute T-cell lymphoblastic leukemia. Due to the patient’s suffering caused by the treatment, her parents decided to stop the chemotherapy and use natural treatments instead. The hospital staff does not support this decision since, without treatment, the girl is likely to have a recurrence of cancer that will be more aggressive and difficult to treat. At the same time, continuing therapy will result in a cure with an 85% probability. It will be argued that, in the given case, parents do not have the right to refuse the life-saving treatment for their child because chemotherapy constitutes ordinary care, it is highly likely to benefit the child and reduce the risk of substantial harm (death), and it serves the child’s best interests.

Ethical Dilemma

An ethical dilemma arises whenever several ethical principles conflict with each other. Healthcare professionals should rely on four main ethical principles in their practice: beneficence, non-maleficence, justice, and autonomy. Beneficence means the obligation to act for the patient’s benefit, while non-maleficence refers to avoiding doing harm to patients. Autonomy is the patient’s ability to exercise his or her right of self-determination, and physicians are obliged to help patients realize this right by telling them the truth, ensuring confidentiality, and obtaining informed consent. Finally, the principle of justice refers to the equitable and fair distribution of healthcare resources among patients.

In the given case, three of these principles are in conflict: beneficence, non-maleficence, and autonomy. Compliance with the principle of beneficence requires healthcare professionals to provide the patient with chemotherapy. However, this treatment causes suffering to the girl, thus violating the principle of non-maleficence. Further, autonomy suggests that individuals are entitled to make informed decisions for themselves. In the case of minors who are incompetent to decide for themselves, their surrogate decision-makers (usually parents) make choices for them. Yet, in the given case, healthcare professionals may violate the principle of autonomy by continuing to provide chemotherapy to the girl despite her parents’ dissent.

Ordinary vs. Extraordinary Medical Care

Healthcare professionals’ moral obligation to provide patients with a life-saving treatment depends on whether this treatment option is ordinary or extraordinary. Ordinary care has the following characteristics: it is commonly used in the given circumstances; an individual can employ this treatment with his or her current psychological, physical, and economic condition; there is a certain hope of proportional benefit. In contrast, extraordinary treatment is not commonly used in the given situation, is difficult or impossible to obtain, causes unbearably strong pain, involves excessive expenditure, or is unlikely to produce proportionate benefits.2(32) While healthcare professionals are morally obliged to provide ordinary care, the provision of extraordinary treatments is optional.

To decide whether the healthcare staff is obliged to continue chemotherapy in the reviewed case, one should determine whether chemotherapy is ordinary or extraordinary treatment under these circumstances. Intensive chemotherapy is a common treatment for patients with acute T-cell lymphoblastic leukemia. The five-year disease-free survival rate of patients who underwent chemotherapy is over 80%,3(4) which shows that Alexa has a definite hope for proportional benefits. Further, the case does not specify that the family cannot afford to pay for Alexa’s treatment or that the girl is physically unable to tolerate the chemotherapy. Although the patient is reported to experience great suffering due to side effects, the suffering is not presented as unbearable. Given the fact that chemotherapy is a common treatment for acute T-cell lymphoblastic leukemia, which is available, affordable, and is highly likely to lead to at least 5-year disease-free survival of the patient, this treatment can be considered ordinary. Therefore, healthcare professionals are morally obliged to continue the provision of chemotherapy to Alexa.

Beneficence Prevailing over Non-Maleficence and Autonomy

Healthcare professionals are expected to follow all ethical principles in their practice. For example, pharmacists give an oath that they will “apply [their] knowledge, experience, and skills to the best of [their] ability to assure optimal outcomes for [their] patients”. At the same time, pharmacists’ Code of Ethics stipulates that “A pharmacist respects the autonomy and dignity of each patient.” In the presented case, these ethical requirements are in conflict, so one needs to decide which principle should dominate.

In the case under review, the principle of beneficence prevails over non-maleficence. Although chemotherapy causes suffering to the patient, it is eventually intended to cure the disease and, thus, save the patient’s life. Hence, healthcare professionals should violate the non-maleficence principle for the patient’s benefit. As for the conflict between autonomy and beneficence, the latter can prevail in the case of a serious life-threatening disease and the urgency to treat it to save the patient’s life. In the given case, acute T-cell lymphoblastic leukemia is a life-threatening condition, and the urgency to treat it is attributed to the fact that if the treatment is delayed, the illness is likely to recur in a more aggressive form. Evidence shows that children’s survival rate after a relapse is lower than 25%. It means that the patient’s life is at high risk if the treatment is not followed through.

In the given case, the consequences of the act can be regarded as the basis for making an ethical decision. Looking at the desired outcome is a characteristic of consequential ethics. If healthcare professionals chose autonomy over beneficence, it could alleviate the patient’s suffering in the short term but lead to negative outcomes in the long term. On the contrary, choosing to act on the principle of beneficence would lead to positive outcomes in the long term and significantly increase the patient’s chances for surviving and having a good quality of life. Thus, from the perspective of consequential ethics, beneficence should prevail over autonomy.

Best Interests of the Child

When resolving ethical dilemmas of parental refusal of life-saving treatment, healthcare professionals are often guided by the best interests principle. When evaluating the patients’ decision, it is necessary to consider whether it is best for the child, all things considered, and whether this decision exposes the child to an obvious risk of harm. In the given case, the parents’ decision to stop the chemotherapy does not meet the child’s health-related and future-looking interests and exposes her to an obvious risk of the disease recurrence, which is much more difficult to treat. Therefore, healthcare professionals should intervene on behalf of the child. Furthermore, the judicial practice shows that healthcare professionals can request state intervention when the child has a life-threatening condition, the proposed treatment is a high likelihood of success, the risks of non-treatment are serious, and the benefits outweigh the risks. In this case, the disease is life-threatening, the treatment has an 85% cure rate, the risk of non-treatment is a relapse with a low survival rate, and the benefits are greater than the risks. Therefore, the chemotherapy should be continued, and if the parents remain reluctant, state intervention may be necessary.


This paper has argued that chemotherapy should be continued in the given case. It has been decided that chemotherapy is an ordinary treatment, which is why healthcare professionals are morally obliged to provide it. Further, the principle of beneficence was found to be prevailing over autonomy and non-maleficence because the child’s condition is life-threatening, and refusal of treatment exposes the child to serious long-term risks.


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