From what I understand in the prompt, I'm a physician. A 16 year old patient comes to me and wants a specific procedure. Her parents are in disagreement with that procedure. I'm kind of asked, who do I have to listen to in this situation?
This is actually a very difficult situation. The ethical dilemma is here on think. First is autonomy versus being able to make a well informed decision and regarding the family's dynamic. Before I say what I would do, there's many perspectives I have to look at. At first there's a perspective of the patient, the 16 year old. Then there's a perspective of the family as well. And the last perspective is the perspective of the physician with the relationship with both the family and the patient. I'm going to discuss a bit of pros and cons within each perspective.
In the perspective of the patient, the patient comes to the physician with trust. They come with, I don't know what the procedure is. This can be a life changing procedure. It can be a procedure that can enhance confidence. It can be a procedure that can treat an illness. Depending on the situation, I think if a patient comes to you with trust, that trust should be taken without the most importance. By accepting that procedure and doing it for the 16 year old, you're allowing them to keep having that confidence of physicians. If you don't do that treatment, you can possibly hinder a future relationship with the physician because the 60 year old might be upset and might not want to seek medical attention anymore. These are important things to consider.
The family's perspective, I think it's a very similar perspective to the child. I know that in most cases, a family really wants what's best for their child. I know that they're looking out for the best interest of their child. We have to understand that maybe they're scared of this procedure. Maybe they don't know what the procedure entails and what the actual reason behind why the 16 year old wants that procedure.
Lastly, it's the physician. The physician, I think, in this situation has to be well informed of the decision he's taking, because he has to make sure that the patient is well informed, that the family is well informed, that he tries his best to keep the relationship as positive as possible through this whole interaction with the disagreement within the family.
For what I would do, if I were to listen to the patient or the family, this is very contextual based. I have to speak with the patient. I have to determine and see if they're in the mental capacity to make such decisions on their own. I have to understand if they understand the risk and complications of the procedure. I also have to see if this is a medically necessary treatment as it might not even be medically necessary. I have to gather that information. I have to know the reasoning of why my patient wants to have this procedure and if they're in the consent, if they're in the capacity to make the decision. If I can tell they're mature enough to make that choice on their own, I don't know if there's an age of consent in Canada, but I would grant that procedure to that patient should it be legal.
Now, if they're not in the capacity and they don't understand what's going on and they want to do it for unnecessary reasons and put unnecessary risk on their body, and I can cause kind of harm to them by doing this procedure, I would not offer the treatment and not because I would listen to the family, but because I don't think it's the right course of action medically.
But in either case, I think the approach I would take is to see if they're well informed, if they have the capacity to make that decision. After I make that choice, regardless of the choice, I will show that I still care for the patient. I will remain as a kind of shoulder to lean on for knowledge after the procedure to give them access to post depends if it's operations like post operative care or follow up procedures or follow up visits to see if that procedure went well.
I will also speak with the family and let them know why I made my choice, that I didn't just do it to undermine them, but I did it because I believe that that procedure was medically necessary and that their child had the capacity to make that choice. But in large, I would try to keep my relationship with both the patient and the family as positive as possible as this may have long term implications on them wanting to seek medical attention and it can have long term negative consequences if I don't maintain that relationship, if they trust in the medical system.