Obligation of clinicians to treat unwilling children and young people: an ethical discussion

Abstract

The refusal of a child or young person to comply with a clinician's recommendations for treatment creates a challenging ethical problem. We describe an approach that seeks to balance the clinician's duty of care to their patient with the need to respect and indeed foster the developing sense of autonomy in young people. Central to this approach is a theory in which the standard of competence required of a patient is flexible and commensurate with the level of medical risk inherent in the decision. High-risk situations require an exacting standard for the determination of competence whereas a lower standard may be accepted where risk is relatively minor. The argument also allows that levels of competence may fluctuate as a result of illness itself and be influenced by social and cultural factors to which a child is perhaps particularly prone. The obligations of treating clinicians in these circumstances are complex but we believe that a moral framework can be offered that clinicians will find useful in the treatment of unwilling children.