When Parents Decline the “Best” Treatment Option: When can state intervention, nudges, and non-disclosure of treatment options be justified

Abstract: When new research findings prove clearly superior to existing treatments, clinicians may recommend altering treatment to allow for improved clinical outcomes; this is especially true for childhood cancer. Although many parents welcome such an opportunity, some may have reservations about new research results, preferring the original treatment plan even when outcomes are less favorable.

Such parental decisions may provoke strong emotions within members of the healthcare team often resulting in frustration and moral distress. To persuade parents to reconsider the newer treatment plan, clinicians may adopt a range of strategies, including employing nudges. When a new treatment significantly improves a child’s chance for cure, should a parent’s reasons against accepting the new approach matter and if so, where does one draw the line? Is the use of nudges ethically permissible in such situations? Are clinicians justified in seeking state intervention to assure treatment with the new, better treatment? During the informed consent process for future patients, is non-disclosure of the previous standard therapy appropriate?

Disagreements are common in our increasingly polarized society. Viewed through the lens of interdisciplinary collaboration, we consider diverse perspectives and the role of nudges, non-disclosure of less efficacious options, and the role of state intervention. To frame the discussion and highlight these themes, we will present the case of a young child with curable cancer whose parents refused to switch their child’s current treatment to the new standard of care. We will engage the audience to share their own insights, including best practices for bridging disagreements.

Keywords: Nudges, Trust, Parental decision-making