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  #1  
Old 07-23-2011
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Medicolegal and Ethics Boy will die and parents do not want you to tell him!

A 7 year male is found to have leukemia and lab data and statistics says that he is going to die in next 6 upcoming months. His parents ask you not tell boy about his disease and prognosis. What should physician do?

a) obey parents request and don't tell boy
b) tell boy regardless of parents will
c) tell parents that i am going to arrange a meeting between doctors for this situation
d) convince parents that child needs to be told about it

Last edited by INCOGNITO; 07-23-2011 at 06:43 PM.
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  #2  
Old 07-23-2011
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I would go with d) convince the parents that child needs to know about it.

Last edited by Hope2Pass; 07-23-2011 at 07:45 PM.
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Old 07-23-2011
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I have a feeling the answer is A
hate dis majority of the answers u feel will be rite wid bs
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Old 07-23-2011
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Quote:
Originally Posted by ricko335 View Post
I have a feeling the answer is A
hate dis majority of the answers u feel will be rite wid bs
You know what...i agree wid u i think it's A since he us 7 i think ur supposed to do what the parents say as they have control over what information the child/minor shud recieve
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Old 07-23-2011
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d) convince parents that child needs to be told about it....

All patients have the right to know (even if the patient is just a kid)
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Old 07-23-2011
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Originally Posted by ricko335 View Post
I have a feeling the answer is A
hate dis majority of the answers u feel will be rite wid bs
If option D was not given then yes, you're right. The answer would be A. But whenever such a question is asked and you have the option of "arrange a meeting to discuss..." or "convince to talk" .. those kinda options are more ethically right since you're not going against the parents wishes nor are you holding information from the pt ... you're trying to convey all the information you can, in the best way possible!
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Old 07-23-2011
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Originally Posted by Hope2Pass View Post
If option D was not given then yes, you're right. The answer would be A. But whenever such a question is asked and you have the option of "arrange a meeting to discuss..." or "convince to talk" .. those kinda options are more ethically right since you're not going against the parents wishes nor are you holding information from the pt ... you're trying to convey all the information you can, in the best way possible!
actually, the second best answer should be b) tell boy regardless of parents will. You dont have to "obey" parents request...
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Old 07-23-2011
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Originally Posted by bebix View Post
actually, the second best answer should be b) tell boy regardless of parents will. You dont have to "obey" parents request...
really ?! I thought the parents make all the decisions for little kids? .. hm so if u go against the parents wishes and tell the boy ..what would that lead do? medical lawsuit ? or some sorta disagreement/ conflict?

Well either way, i dont think usmle questions will take out option D in such questions!
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Old 07-23-2011
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it shud b A. . . .the child is too young 2 b told abt it
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Old 07-23-2011
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A) too young be told !
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Old 07-23-2011
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Old 07-23-2011
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well the child above 6yrs understands the concept of death n parents hve authority of making decision regarding child health unless its a life threatening situation where parents re interfering with doctors duty
so ill go with D....
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  #13  
Old 07-24-2011
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Actually no, You dont tell the kid unless parents say so, this is not a matter of emergency where you do the best interest, even if the case says : "You Just diagnose Leukemia, should you tell the kid ? No, parents decide what to tell...

In other word, the question is asking "Who decides what to tell to the kid" ?

Always the parents have the right, This rule does not cover life-threatening or serious emergencies (where the doctors decide for the best interest of the kid).

The best way to act as a doctor here is to tell the parents to talk about it... Answer D. " always encourage patient to talk their problems", then the Next best answer is A.

If you choose Option B, mostly you will be sue, you are liable for that.
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Old 07-24-2011
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I will go for A. For two reasons. 1: he is a minor, so parent consent take the order. 2: the Childs perception of death for is age is not fully grown to understanding that death is irreversible, inevitable and universal.
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Old 07-24-2011
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Default I'll go for A too

I say A too
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Old 07-24-2011
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Unhappy so what is final consensus

Is there no way to poll the answer or an authority to say yes this is the right answer?
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Old 07-24-2011
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Star Patient! Patient! Patient!!!

d) convince parents that child needs to be told about it
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Old 07-24-2011
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Quote:
Originally Posted by rulz View Post
Actually no, You dont tell the kid unless parents say so, this is not a matter of emergency where you do the best interest, even if the case says : "You Just diagnose Leukemia, should you tell the kid ? No, parents decide what to tell...

In other word, the question is asking "Who decides what to tell to the kid" ?

Always the parents have the right, This rule does not cover life-threatening or serious emergencies (where the doctors decide for the best interest of the kid).

The best way to act as a doctor here is to tell the parents to talk about it... Answer D. " always encourage patient to talk their problems", then the Next best answer is A.

If you choose Option B, mostly you will be sue, you are liable for that.
I think in this particular case the answer is D).

But what if the parents say "we don't want to discuss this" and "we're not going to tell him that he has cancer, period!"...Im not sure that "don't tell the kid unless parents say so" is the right ethical answer...
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Old 07-24-2011
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ANS: d convince the parents that the child needs to know.parents are in denial and not ready to accept.eventually the child will have to be told.
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Old 07-24-2011
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Quote:
Originally Posted by bebix View Post
I think in this particular case the answer is D).

But what if the parents say "we don't want to discuss this" and "we're not going to tell him that he has cancer, period!"...Im not sure that "don't tell the kid unless parents say so" is the right ethical answer...
In fact, the ethical here is to tell the parents to talk to his kid, and the best next answer is A, Parents have the rights to decide what to tell to the kid, even in these circumstances. So, when i said "Dont tell the kid if parents say so" IS the same, if they decide not to tell the kids, we have to obey that and dont tell, if we do, we are liable.
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  #21  
Old 07-24-2011
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well the child above 6yrs understands the concept of death n parents hve authority of making decision regarding child health unless its a lifr threatening situation where parents re interfering with doctors duty
so ill go with D....
Btw, actually is above 8-9 years old that they understand that death is universal, inevitable and irreversible.
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  #22  
Old 07-24-2011
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Originally Posted by rulz View Post
In fact, the ethical here is to tell the parents to talk to his kid, and the best next answer is A, Parents have the rights to decide what to tell to the kid, even in these circumstances. So, when i said "Dont tell the kid if parents say so" IS the same, if they decide not to tell the kids, we have to obey that and dont tell, if we do, we are liable.
Totally agree. Answer is A.
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  #23  
Old 07-24-2011
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Correct Answer Answer is D

Quote:
Originally Posted by jorgemorales View Post
Totally agree. Answer is A.
Yeap, That's the Correct answer if D is not on the choices list...

i would recomend to read the "100 Most cases presently on USMLE step 1" by conrad fisher... it is a great book to understand must of Ethical Situations...

for USMLE, if you see any answer saying "Make patient talk to their relatives or something like encourage family or patient to discuss their problem" that's the best answer to take, which in this case or clinical vignette is Answer D.

Think about it, if you convince the parents to tell the kid, its a win-win. Kids finally gets to be told and parents go over their "denial" or some of the kluver-gross stages.
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Old 07-24-2011
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Quote:
Originally Posted by rulz View Post
Btw, actually is above 8-9 years old that they understand that death is universal, inevitable and irreversible.
I thought it was 11+ years?
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  #25  
Old 07-24-2011
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I thought it was 11+ years?
No, In fact, on Med-Essential establish that is after 8-9 year old.
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Old 07-24-2011
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No, In fact, on Med-Essential establish that is after 8-9 year old.
What does it say about a 6 year old?
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Old 07-24-2011
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Quote:
Originally Posted by Mashee View Post
What does it say about a 6 year old?
Let me show you a pic =) talks better hehee..


From Med-Essential
2010 Page 7

Boy will die and parents do not want you to tell him!-img_0057.jpg
click image to enlarge
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Old 07-24-2011
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Originally Posted by rulz View Post
Let me show you a pic =) talks better hehee..


From Med-Essential
2010 Page 7
Wow Thanks
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  #29  
Old 07-24-2011
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With regard to child development, got this from medline (crazy it's not in FA at all, and Kaplan behavioral science doesn't go into much detail.

Child's concept of death:

Death should be discussed honestly and in language that children can understand at their stage of development. A child's concept of death varies with age, and this must be taken into consideration.
Age 0 - 2 years:
  • Sees death as separation or abandonment
  • Has no cognitive understanding of death
  • Feels despair from disruption of caretaking
Age 2 - 6 years:
  • Often believes that death is reversible, temporary
  • May perceive death as a punishment
  • Engages in magical thinking that wishes come true -- may feel guilt for negative feelings toward the person who died, and think that was the cause of death
Age 6 - 11 years:
  • Shows gradual understanding of irreversibility and finality of death
  • Demonstrates concrete reasoning with ability to comprehend cause and effect relationship
Age 11 years or older:
  • Understands that death is irreversible, universal, and inevitable
  • Has abstract and philosophical thinking
This is what i had written down in my FA...It was posted by heights when we were discussing the free 150 qs...here it says that it should be 11+ that they understand that death is irreversible etc., but from 6-11 they are gradually understanding the irreversiblity and finality of death...
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Old 07-24-2011
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Thanks, i will keep in mind that.. =)

hehehe =)
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  #31  
Old 07-24-2011
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As With all behavioral questions that I face...The answer is probably A.
But personally, I'd maybe lean towards D, to atleast have a discussion with them about it. and with a child psychiatrist/psychologist to asses whether its appropriate or not...its probably not rocket science for most people, but I get a bit freaked when it comes to kids!
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Old 07-24-2011
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i think i'll go with d
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Old 07-24-2011
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Post A

the answer is A , i think , because the boy is only seven he is not aware what leukemia means ...and about the prognosis....i think it's important to till a child at this age in cases of chronic diseases or disease that needs understanding and cooperation from the pt. him self ..like for ex. type 1 DM ...it's important to teach the pt. about his disease bcz this will be a life long disease so understanding and cooperation is very important in the management.and to help pt. coping with his new life easily...unlike leukemia....
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  #34  
Old 07-24-2011
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D. convince parents that child needs to be told about it..

"tell the boy in words that he can understand that he is dying", that is after you get permission from the parents to tell the patient...... (Source, Kaplan Lecture Notes)
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Old 07-24-2011
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a) obey parents request and don't tell boy
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  #36  
Old 07-24-2011
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So whats the answer?
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  #37  
Old 07-25-2011
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The answer is D.
A patient still needs time to go through the stages of adjustment, that's why it is necessary to tell as soon as it is possible. In this case the child is 7, so probably he doesn't understand, and may see it as a punishment, so the goal of a parent is to explain that it is not true. This q was discussed in one of the lectures by daugherty.
Bottomline: talk to parents first, work with them, encourage to tell the kid, as an option, be there with them to talk to the kid. It may take several attempts.

Last edited by tigriki; 07-25-2011 at 12:25 PM.
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  #38  
Old 07-25-2011
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Correct Answer correct answer

its

D. convince parents that child needs to be told about it.

i think its pretty clear to every one as 800 views to this question in two days
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Old 07-25-2011
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Quote:
Originally Posted by dr-ahmed View Post
i say a too
d....i have seen this question in nbme form..dont remember which form!!!
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Old 07-26-2011
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FA (2010 P.61): patients of a child decide what information can be relayed about the illness.

Anybody can explain this?
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  #41  
Old 07-26-2011
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Quote:
Originally Posted by USMLEBoy View Post
FA (2010 P.61): patients of a child decide what information can be relayed about the illness.

Anybody can explain this?
Parents decide what to tell to the kids... No matter the diagnosis, they are the one who got to tell their kids, Doctors should instruct parents to works things with the kids, but if parents decide not to tell, you are not allow to tell the kid if they have or not a disease... Is parents rights.
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Old 07-26-2011
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the answer is D. Oh ya...child is too young to understand the concept of life and death..........
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Old 07-26-2011
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i still not agree with the answer ....i don't think that a boy aged 7yrs will understand what death means and why he is going to die ... regardless what books say........I'm not convinced.... ........from our daily dealing with children in such age i think they are too young .......
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I will also choose option a.. as the child age is just 7 years. So, it will be not good to tell him.
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