Experimental Medical Treatment for a Terminal Pediatric Patient: Commentary on Asai and Itai

- Frank J. Leavitt, Ph.D.
Chairman, The Centre for International Bioethics
Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
Email: yeruham@bgumail.bgu.ac.il

Eubios Journal of Asian and International Bioethics 14 (2004), 57.

I always learn a great deal from Asai and Itai 's case studies. They are based on their personal, hands-on experience with patients. In reading, one feels their personal concern. I have to admit, however, that with respect to this particular case I cannot agree with them. Please forgive my simplistic approach, but I think the matter is summed up in their statement that while: "...we are incapable of calculating which will be best for him. Omission will inevitably result in letting him pass away." If the inevitable result of omission is death, then why not try something even if the presumed success rate is only 15%? Asai and Itai talk about the cruelty of giving the parents "false hope". This is a serious matter. But why need the proposal of an EMT be phrased in such a way as to give false hope? The physicians have to find a way to explain to the parents that they would like to try this therapy as a last resort, while aware that the chances of success are almost non-existent.

Asai and Itai discuss at length the complications of the approach to the institutional review board (IRB). But I doubt that ethics require turning to an IRB in such a case. The World Medical Association Declaration of Helsinki [http://www.wma.net/e/policy/b3.htm] is God's Revealed Word about ethics. It can certainly be wrong. But their guidelines for medical experimentation on human subjects are extremely useful and often show a good deal of wisdom. Paragraph 32 of the most recent version says:

"In the treatment of a patient, where proven prophylactic, diagnostic and therapeutic methods do not exist or have been ineffective, the physician, with informed consent from the patient, must be free to use unproven or new prophylactic, diagnostic and therapeutic measures, if in the physician's judgement it offers hope of saving life, re-establishing health or alleviating suffering. Where possible, these measures should be made the object of research, designed to evaluate their safety and efficacy. In all cases, new information should be recorded and, where appropriate, published. The other relevant guidelines of this Declaration should be followed. "

I think that whoever wrote this guideline showed a great deal of wisdom in recognizing that when the alternative is certain failure, ethical restrictions should be liberalized.

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