同意與贊同－－青少年接受骨髓移植之倫理考量

Consent vs. Assent: Ethical Considerations Related to Bone Marrow Transplantation in Adolescents

為罹癌兒童進行骨髓移植治療乃為拯救性命或治癒疾病，然該治療常伴隨嚴重副作用，讓孩童身心靈飽受痛苦與磨難，故治療過程常令人質疑是否真正使病人受惠。再者兒科醫療照護中往往忽略孩子的治療意願與偏好，治療與否的決定多以取得父母之同意為主，故本文將針對此現象，以最佳利益觀點為基礎，應用兒科醫療倫理中對青少年行使同意權及贊同權之論述，分析一位青少年接受骨髓移植之倫理決策過程，最後提出治療過程中醫護人員應盡力維護兒童之贊同權，然而亦不可忽略父母為兒童醫療照護之重要決策角色，故應透過溝通讓父母瞭解兒童贊同之重要性，並在符合父母及家庭之期待下，促成孩子與父母間之溝通與協商，以嘗試解決照護困境。倘若父母與孩子的治療意願衝突仍無法解決，必要時可尋求醫院的倫理委員會協助，以便能取得更周全的建議與可行之策略。

Bone marrow transplantation (BMT) is a frequently considered treatment option for terminal childhood cancer. However, the side effects of BMT frequently cause short- and long-term physical discomfort and spiritual suffering, which significantly impact patient quality of life. In Taiwan, parental consent is typically given priority over the assent of children in medical decisions. This article uses a case of an adolescent patient with neuroblastoma undergoing BMT to discuss the best interest standard and contradictions between the consent of parents and the assent of their children. This article argues that medical staffs are responsible to protect the right of children to fully consider and influence the decisions related to their treatment options. Medical staffs should communicate to parents the importance of their children's assent and promote better communication between parents and their children in order to achieve the best outcome for the family as a whole. When mutual communication is unable to resolve conflicts between parents and their children, we recommend seeking assistance from the ethics committee in the hospital.