Continue to treat Andrew despite his comments, because she believes that the treatment is what's best for him?
A few days after Andrew is advised of his diagnosis, he asks to speak to Dr Simpson alone, as he knows his parents won't agree with what he has to say.
Andrew, who is now twelve, has just been diagnosed with cancer for the second time.
Is everything okay, Andrew? I can see you've got something important to say to me.
I don't want any more treatment. I've really thought about this. I was so ill the last time.
But this treatment is necessary to save your life.
I know that, but what is the point if I never get to do any of the stuff my mates do? All I do is lie in a hospital bed. I know you think I'm just a kid, but it's my life, it's not up to you to decide.
Andrew, I know it must be hard for you, but hopefully the treatment will make you better, and then you will be able to do the same things as your friends.
Yeah right, that's what you said last time. Listen... I just want to be left alone now, and enjoy what's left. This treatment just makes me feel worse.
Dr Simpson asked a counsellor with experience of working with young people to discuss Andrew's concerns with him, and also with his parents. The counsellor was able to allay Andrew's fears about his treatment and Dr Simpson provided reassurance that he would be involved in the decision-making as his treatment progressed. Andrew agreed to begin the treatment, and Dr Simpson agreed that she would review his progress with him at regular intervals.
Respect for young people's views is important in making decisions about their care. If they refuse treatment, particularly treatment that could save their life or prevent serious deterioration in their health, this presents a challenge that you need to consider carefully.
Parents cannot override the competent consent of a young person to treatment that you consider is in their best interests. But you can rely on parental consent when a child lacks the capacity to consent. In Scotland parents cannot authorise treatment a competent young person has refused10. In England, Wales and Northern Ireland, the law on parents overriding young people's competent refusal is complex11. You should seek legal advice if you think treatment is in the best interests of a competent young person who refuses12.
You must carefully weigh up the harm to the rights of children and young people of overriding their refusal against the benefits of treatment, so that decisions can be taken in their best interests13. In these circumstances, you should consider involving other members of the multi-disciplinary team, an independent advocate, or a named or designated doctor for child protection. Legal advice may be helpful in deciding whether you should apply to the court to resolve disputes about best interests that cannot be resolved informally.
You should also consider involving these same colleagues before seeking legal advice if parents refuse treatment that is clearly in the best interests of a child or young person who lacks capacity, or if both a young person with capacity and their parents refuse such treatment.
(0-18: guidance for all doctors, paragraphs 30-33)