Ethics Resolution Assignment

Students in the group: Kirsten, Emma, Vanessa, and Eva

Name of scenario: Scenario 2- Brain Cancer

You are a supervisor at an acute care children’s hospital. A twelve-year-old boy is being treated
for neurological motor impairments following the removal of a cancerous tumor. The boy was
brought to the hospital originally following a concussion in a sporting event. The tumor was
located after a medical work up for a concussion. The family does not want their son to know
about the cancer and would like the staff to focus on rehabilitation. The Oncologist has given
the child a very poor prognosis for recovery.

Framework for ethical decision-making: Answer the following questions in your group. In
each of the scenarios, you are the manager and will need to think about how the approach you
take will affect all parties.

List all of the involved parties: Make sure you consider the whole scope of the problem and list
everyone who may be affected by any decision you make.

● Rehabilitation staff
● Family/Parents
● Oncologist
● Child
● Supervisor (us)
● Medical/acute staff

Consider the OT ethical standards: Review the ethical standards and create a bullet list the
principles that apply to the main parties (you do not need to write an explanation of your
choices).

● Beneficence
● Nonmaleficence
● Veracity
● Autonomy

Frame the problem: As the manager, you will need to explain the problem to the main involved
parties from the standpoint of their own involvement. Select the main 2-3 people involved and
write a paragraph framing the problem to each of them. Consider each of their unique
perspectives and explain the problem in factual and non-blaming terms.

Parents: We respect your right to make decisions for your child and your desire to protect them.
You understand your child and his needs better than we do and we know you want to do what is
best for him during this time. We want to ensure that his quality of life is the best it can be and
that is where OT comes in. Typically in rehab we would focus on basic daily living skills, but
perhaps for your son it would be more meaningful to spend our time in therapy doing activities
that are important to him, like recreation with friends or other activities that he enjoys spending
time on. We understand that you might not be ready to tell your son about his prognosis yet and
that is your decision. When the time comes for you to tell him, we want you to be prepared and
have the right tools, so we can provide you with some resources and ideas for how to have that
conversation. As far as therapy goes, we strive to have open dialogue with the kids and want
them to be able to talk about what’s going on. So from this perspective, we want you to be
aware that these conversations can come up and rehab staff will do our best to navigate it with
your wishes in mind, but it could be a good time for him to talk about it with people who aren’t so
close to him.

Rehab staff: We understand that everyone is going to have different feelings on this situation
and want to address it in a delicate way. We can make recommendations in a delicate manner if
a conversation arises with the parents, however, I would like you to respect that ultimately the
parents have the right to make decisions for their child. I will be talking to the parents to see
which direction they would like us to go with our occupational therapy and will let you know what
they decide.

What do you know, what do you need to know, and what resources can you use to supplement
your understanding: It is important to make as informed a decision as possible. Make a bullet
list of the facts you know, then make a two-column table with a line item list of the information
you need and a source you could go reference to get the information.

What we know Need to know Resources

● A 12 yr old boy with 1. If parents plan to tell 1. Counselor/social work

poor prognosis on him eventually on
brain cancer tumor their own time
that has been 2. What direction
removed. parents would like us
● Is being seen for to treat for occupation
neurological motor right now
impairment. 3. What is the
● Child thinks he has a oncologist’s views and
concussion. experiences with this
● Parents don’t want to situation and are the
tell him his diagnosis family in discussion
or prognosis. with the oncologist
● Acute care setting about this issue.In this
● Concussion from discussion we could
sports accident ask for details on
● Interactions between diagnosis and
child and therapist prognosis from
could bring up oncologist.
conversation about 4. How to support the
prognosis. therapists in working
with the child and
managing
conversations that
may come up with the
child that touch on this
issue.
at hospital for parents
to talk to, book on
Crucial Conversations
or other resources on
difficult conversations,
AOTA Ethics
Commission, St.
Jude’s website for
education/support in
talking to your child
about a brain tumor
2. Interview/discussion
with parents and
oncologist
3. Discussion with
oncologist, legal
counsel to give
guidance on laws
pertaining to rights of
parents and minors in
this situation.
4. AOTA code of ethics
or ethics commission,
Crucial Conversations
book, and explaining
that you support the
therapists and they
can talk to you if they
ever feel the need.
Make a decision: What course of action will you choose and why. Give details about how each
of the interested parties will be affected by your decision. This will not be a short answer. As the
manager, you will have to help all parties get “on board” with your decision to the extent that you
can. This is the crux of being a good manager. The ability to communicate difficult decisions to
all parties and help them understand the whole picture (at the appropriate level). Write up the
course of action you will take and then write a paragraph to each of the main interested parties,
explaining your decision as it relates to them.

● Course of Action:

We have chosen to ultimately respect what decision the parents make for their child,
because we feel that it is their role as parents to decide when and if to tell the child. We think it
is important that they do tell the child, so we will have ongoing conversations with them about
how to manage that and what the benefits can be for the child in his treatment. We want the
parents to know that we recognize the difficulty in this decision and want to provide as many
supports and resources available to them. We will help them connect with support within the
hospital system and provide resources, such as books or information that is available online to
help them with their own grieving process and how to talk to their son about his medical
condition. Regarding his therapy while in acute care, we can explain that as occupational
therapists we treat the entire person and part of this could be the psychosocial aspects of the
child knowing his condition if the parents decide to tell the child. We would educate the parents
on how keeping his diagnosis from him could impact him negatively psychologically if his
condition worsens despite his efforts in therapy to improve. Some rehab staff may not agree
with this decision, so we need to emphasize that it is ultimately the parents’ decision and we
need to respect them telling him on their own time.

● Parents:

We would like to explain to the parents the benefits of letting their child know what is
going on and recommend them to resources that can help them to approach this conversation
with their child such as Crucial Conversations book and St Jude’s Hospital’s website. As
similarly stated above, we would explain that we support the parents in whatever decision they
ultimately make for their child but also would like to support the child in their rehab through all
aspects including psychosocial aspects. We can also recommend that if the parents desire we
can recommend support groups for the parents and/or the child to seek out throughout this
condition.

● Rehab staff:

We would explain to the rehab staff that we will talk with the parents about the benefits
of informing the child of his diagnosis and prognosis. However, if the parents ultimately
determine that they do not ever want to tell their child, we want the staff to feel supported in
honoring the parents decisions, despite any disagreements they may have with it. We would
encourage open communication among staff members about their feelings in a safe
environment, such as staff meetings or one on one meetings with us. We would also remind
them that we need to be respectful and professional in our conduct with the parents. Provide
training to the therapists on ways they can manage conversations with the child if he asks
questions about his prognosis, while maintaining the wishes of the parents.