In the face of a terminal illness, a child asks of her parents to do the heart-wrenching unimaginable: to let her choose heaven over going through another trip to the hospital.
But does little Julianna Snow truly understand what she was asking for? Some psychiatrists don't think she does.
The Australian girl who just turned five years old was diagnosed with a terminal neurodegenerative illness, the Charcot-Marie-Tooth disease, characterized by paralysis and weakness but intact cognitive functions. She had become so weak that a mere cold could spell a threat to her life. She is still surviving because of prescribed treatments, though doctors warn that even these will no longer be enough to save her the next time she falls ill.
When she later told her parents that she no longer wanted to undergo further treatment the next time she becomes ill, her parents decided to concede to her request.
"She made it clear that she doesn't want to go through the hospital again," Michelle Moon, Julianna's mother, wrote in an email to CNN. "So we had to let go of that plan because it was selfish."
The medical community and the public are still debating on the ethical implications of this course of action. While some gave their support to the Snows, others criticized them for thinking that a child is able to understand enough to make life-or-death decisions.
From a psychiatrist's stand point, however, the argument that young children don't have a clear understanding of death still stands. Children six years old and below tend to think that death is temporary and reversible.
At this stage, children adopt a "magical thinking" view of death and can be reversed through the use of magic words, thoughts or actions, or that death is merely a punishment for bad behavior that can be lifted. They may also have difficulty understanding the concept of heaven or hell.
Knowing this, it is unusual for doctors to ask children to make such crucial life and death decisions, especially when it comes to their own.
"You wouldn't normally ask a child to make crucial decisions because they lack the ability to understand completely the circumstances or the complexity of the situation," said Professor Paul Komesaroff, director of the Centre for Ethics in Medicine and Society at Monash University.
However, Komesaroff added that he can understand why her parents asked Julianna and believes that it is not a case of the parents wanting to be relieved of the responsibility of caring for a terminally ill child.
"I see it as a genuine act of concern and love, in which they've introduced the aspect of respect for the little child herself," Komesaroff explained.
Bridget Haire of the University of NSW said that the decision to continue Julianna's treatment is one that lies with all the members of her family but respects that Julianna should have a say in the matter as well.
"A person, however young, is going to have some idea of what is or isn't acceptable to them," Haire said, adding that Julianna's decision to stay at home over undergoing further treatment is a decision that shows emphasis on the importance of quality over prolonging life.
More on Julianna and her family's inspiring story can be read on their family blog.
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