Sirvent N
Service de Pédiatrie, CHU de Nice, Hôpital Archet 2, 151 Avenue de Saint Antoine Ginestière, Nice cedex 3, France.
Arch Pediatr. 2010 Feb;17 Suppl 1:S16-25. doi: 10.1016/S0929-693X(10)70004-X.
In paediatric oncology, the medical decision-making process is characterized by the importance of what is at stake: the vital prognosis. Refusal of care, or, more specifically, refusal of a treatment, always appears "at the crossroads of multiple stakes... implicating an entourage [family members], a medical team, and rules of law that sometimes give rise to contradictory interpretations". Paradoxes in the judicial institution are evident on two levels: i) in the values established by the law; where adults are concerned, the law explicitly refuses to consider the biological survival of an individual as the supreme value; it gives priority to respect of the patient's wishes and his or her autonomy; for children, in contrast, the supreme value established by the law is biological survival; the physician must provide the care indispensable to protect the health of a minor at all cost; ii) between legal texts and jurisprudence; while the law authorizes a physician to override the parental authority when he judges a treatment necessary to protect the health of a minor, jurisprudence in pediatric oncology has always declined to define the best therapeutic strategy where a child's chances of survival are concerned.
在儿科肿瘤学中，医疗决策过程的特点在于利害关系重大：关乎生死预后。拒绝治疗，或者更具体地说，拒绝某种治疗，总是出现在“多种利害关系的交叉点上……涉及亲属（家庭成员）、医疗团队以及有时会引发相互矛盾解释的法律规则”。司法机构中的矛盾在两个层面上显而易见：其一）在法律确立的价值观方面；就成年人而言，法律明确拒绝将个人的生物性生存视为至高无上的价值；它优先考虑尊重患者的意愿及其自主性；相比之下，对于儿童，法律确立的至高无上的价值是生物性生存；医生必须不惜一切代价提供保护未成年人健康所必需的治疗；其二）在法律文本与判例法之间；虽然法律授权医生在判断某种治疗对保护未成年人健康必不可少时可以推翻家长的权威，但儿科肿瘤学的判例法一直拒绝界定在涉及儿童生存机会时的最佳治疗策略。
