In episode 59 we shared a sampler of the Essential Ethics podcast from the Children's Bioethics Centre, at the Royal Children’s Hospital, Melbourne. A couple of cases studies were presented to help us define “the Zone of Parental Discretion” – a space in which decision-making about a child’s medical care is conceded to parents even if it’s not optimal clinical management.

Today’s thought experiments come from the oncology department. First, we’re asked to consider when an adolescent should be permitted to make autonomous decisions about their health, even if these would lead to worse clinical outcomes. How does a clinical team decide whether to accept this wish or to override it? 
 
 In the second case study, the final outcome has already been determined by an incurable brain tumour. A 14 year old girl has been diagnosed with a high grade medulloblastoma. Therapy has little chance of cure but around 30% of patients have their life prolonged by 2 or 3 years but comes with disabling side effects. The parents want to bypass recommended treatment and try prayer and natural therapies instead . Does this terminal prognosis broaden the zone of parental discretion, and how can the clinical team help the family with the terrible choices they have to make? 

Guests
Prof John Massie FRACP (Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute)
Associate Professor Clare Delany (Children’s Bioethics Centre, University of Melbourne)
Diane Hanna FRACP (Royal Children’s Hospital, Melbourne, Walter and Eliza Hall Institute of Medical Research)
Kanika Bhatia FRACP (Royal Children’s Hospital, Melbourne)
Molly Williams FRACP, FAChPM (Royal Children’s Hospital, Melbourne)
 
Production
Written and produced by Mic Cavazzini. Music courtesy of Free Music Archive includes ‘A Path Unwinding’ , ‘The Air Escaping’ and ‘Vittoro’ by Blue Dot Sessions. Image licenced from Shutterstock.

Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Lisa Mounsey.

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.