Medical neglect and refusal of care — OSCE

Liam is a four-year-old boy brought to the paediatric oncology day unit three days after a bone-marrow biopsy confirmed standard-risk acute lymphoblastic leukaemia. The treating team has explained that the standard chemotherapy protocol offers a cure rate above ninety per cent and that induction must begin within the next week. His parents, Sarah and David, have attended every appointment, understand the diagnosis, and are loving and attentive — they have no mental illness, substance use, or access barriers. Today they tell you they have decided to refuse chemotherapy and treat the cancer with herbal remedies, dietary changes, and prayer. They are frightened of the side effects they have read about online, and they believe the conventional treatment will do more harm than the disease. Liam is clinically stable but his counts show early marrow failure, and the oncologist warns that the induction window is narrow. The parents have signed a refusal-of-treatment form and are preparing to take Liam home.