Case Report
 
Refusal of treatment in a young patient with recurrent medulloblastoma
Aaron C. Tan1, Ian H. Kerridger2, 3, 4, Nick Pavlakis1, 4
1Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
2Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
3Centre for Values, Ethics and the Law in Medicine, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
4Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia

Article ID: 100048Z10AT2018
doi: 10.5348/Z10-2018-48-CR

Corresponding Author:
Aaron C. Tan,
Northern Sydney Cancer Centre, Royal North Shore Hospital,
St Leonards, NSW, Australia, 2065

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How to cite this article
Tan AC, Kerridge IH, Pavlakis N. Refusal of treatment in a young patient with recurrent medulloblastoma. J Case Rep Images Oncology 2018;4:100048Z10AT2018.


ABSTRACT
Introduction:Patient autonomy represents a principal tenet of modern oncology. When patients decline treatment in direct contrast with an oncologist's recommendations, it is important to distinguish between an expression of different attitudes, values and beliefs, and an irrational preference. This case report explores the legal and ethical implications of treatment refusal.
Case Report:A 29-year-old male was found to have recurrent medulloblastoma, and declined curative intent high-dose chemotherapy and autologous stem cell rescue. He had a strong belief that prayer would resolve his disease, and he died 18 months following recurrence.
Conclusion: As cancer therapy progresses to an era of personalized treatments with improved prognosis, an understanding of a patient's values and beliefs which underpin their decision is crucial. It is important to avoid imposing a physician's own beliefs in judgement of a patient's decision to refuse treatment, to maintain a trusting relationship and preserve patient's autonomy.

Keywords: Medical ethics, Medulloblastoma, Patient autonomy, Treatment refusal



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Author Contributions
Aaron C. Tan – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Ian H. Kerridge – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nick Pavlakis – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2018 Aaron C. Tan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.