The Child with a Brain Tumour: Vulnerability Perspectives from Neurosurgery

Malignant paediatric brain tumours remain incurable despite advancements in medical knowledge. Understandably, a child with a malignant brain tumour will face several difficult issues. First and foremost, the patient may be too young to understand the disease and what treatment entails. This is because, children by virtue of their age, physical and psychosocial immaturity, are assumed to lack the capacity for autonomous decision-making: either owing to their lack of capacity to understand what is involved, or because they are particularly vulnerable to being influenced by others. Next, the malignant brain tumour has a grim, albeit incurable prognosis. Clinical treatment may include the use of trial drugs whose benefits remain uncertain, or in unfortunate cases cause undesirable side effects on the already ill patient. Despite best efforts, potential cures for efficacious treatment in such diseases are either still in the midst of discovery, or at early stages of pre-clinical testing. Clinical trials that confer significance in disease impact have been demonstrated to be modestly few. To make matters worse, approximately only 10% of the drugs that begin preclinical testing ever make it to human testing. Following that, usually one of these five will ever be approved for human usage. These circumstances hence translate to a painful reality whereby limited options exist for the disease-afflicted child and their concerned parents. As such, it will not be unexpected that the process of decision-making for these patients can be a demanding challenge for the parents involved.