A 15 year-old female is asked whether she would consent to being a bone marrow donor for her mother who is critically ill and in need of a bone marrow transplant. The two of them have had a close relationship with the adolescent daughter occasionally acting out. However, a bone marrow transplant is not a risk-free procedure, the younger family member may cause coercion, and having the daughter more involved in the care may cause her to feel more responsible for the outcome. You are called onto an ethics committee to rule on the topic.
How would you opine?
- In favor: the daughter has autonomy and is able to make her own medical decisions (autonomy)
- In favor: the mother’s risk of dying is the most important aspect of the case and this transplant will allow her to live (justice)
- Opposed: risk of emotional damage is too high given familial involvement in care and the young age of the patient (nonmaleficence, justice)
- Opposed: coercion due to emotional pressure and familial involvement (autonomy, nonmaleficence)
Survey Results
Additional commentary included that “As long as there is sufficient evidence to rule out coercion, the daughter has the ability to make her own medical decisions and should be able to help her mother. In addition, we have to consider that her not giving the transplant might weigh on her conscious [sic], as she feels she did not help her mother in need.”
Clinical Results
After careful consideration to ensure coercion was not a factor, ethical consult ruled that the patient had the autonomy to make her own medical decisions. Mother and daughter underwent transplant, and they are both well.
For more situations and opinions on pediatric donations and organ donations, here are a few articles on the subject!
- AMA Journal of Ethics: “Should Children be Asked to be Bone Marrow Donors for Siblings?” from Jan 2016 (http://journalofethics.ama-assn.org/2016/01/ecas3-1601.html)
- BMC Medical Ethics: “The policy statement of the American academy of pediatrics- children as hematopoietic stem cell donors- a proposal of modifications for application in the UK” from 2013 (http://bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-14-43)
We look forward to your submissions for this month’s ethical question!
Alexandra Cooke and Samuel Timm, MS1's, are The Differential's current medical ethics team. Please visit the Editors section for their contact information and biographies.