A 12-year-old with a terminal illness asks about prognosis, but his parents want the doctors to withhold bad news. What should the physician do first?

A 12-year-old with a terminal illness asks about prognosis, but his parents want the doctors to withhold bad news. What should the physician do first?

• A. Refuse to discuss prognosis with anyone.
• B. First assess the child's understanding, then disclose if appropriate.
• C. Tell the child prognosis immediately and ignore the parents.
• D. Respect the parents' request to withhold information regardless of the child's understanding.

Answer: (B)

Starting with the child’s ability to understand is essential because a 12-year-old can grasp serious news to some extent, and the conversation should be tailored to their developmental level. The physician should first explore what the child already thinks about the illness, what questions they have, and how much detail they want to know, ideally with the parents present. If the child shows readiness, the physician can share information about prognosis in clear, age-appropriate terms and check for understanding, while offering support and answering questions. The parents’ wish to withhold information is important, but it should be balanced with the child’s need to be informed to participate in decisions appropriate for their age and situation. This approach protects trust, supports the family, and respects the child’s evolving autonomy, making it the best choice.

Starting with the child’s ability to understand is essential because a 12-year-old can grasp serious news to some extent, and the conversation should be tailored to their developmental level. The physician should first explore what the child already thinks about the illness, what questions they have, and how much detail they want to know, ideally with the parents present. If the child shows readiness, the physician can share information about prognosis in clear, age-appropriate terms and check for understanding, while offering support and answering questions. The parents’ wish to withhold information is important, but it should be balanced with the child’s need to be informed to participate in decisions appropriate for their age and situation. This approach protects trust, supports the family, and respects the child’s evolving autonomy, making it the best choice.