Consider the ethical dilemmas in the following case study. Be prepared to participate in a class or online discussion to be scheduled by your instructor.

Andrew, an 8-year-old boy, was diagnosed with leukemia 3 years ago. Initially treated with chemotherapy, he went into remission for several months but now has relapsed. The initial round of chemotherapy was very difficult for Andrew, and he experienced all the major side effects, including persistent nausea and vomiting, mouth ulcerations, hair loss, decreased white blood cell count, infections, and generalized muscle wasting and weakness. He developed a deep fear of needles and IVs and still has ecchymotic areas from the bone marrow aspirations. Andrew was and is still unable to play with his friends because of the fear of infection, is 2 years behind in school, and generally feels that his life is worthless.

The physicians have told his parents that further chemotherapy would be dangerous and probably not effective and that a bone marrow transplant is the only realistic hope for a cure. The family and Andrew were informed of what would be involved in a bone marrow transplant, including massive doses of chemotherapy and radiation to destroy his own bone marrow, marrow transfusions, and 4 to 6 weeks of reverse isolation in the intensive care unit after the procedure. Because of graft-versus-host rejection, there is only a 40% chance of success and a 15% chance that the child will die from the procedure itself. In addition, the family’s health insurance will cover only about 25% of the $500,000 cost of the procedure. Andrew’s father already took out a second mortgage on his house to help pay for the chemotherapy.

Which factors would be key in making a decision about whether Andrew should receive a bone marrow transplant?

How do the percentages for survival and success figure into your decision? What if the success rate were 90%? What if there were no risk of death?

How would you respond to the parents if they asked you: “What do you think we should do?”

Who in addition to the parents, physicians, and nurses should be involved in the decision? How do Andrew’s feelings affect the decision?