There are some times when it seems that no decision can be the right decision but doing nothing is as much as a decision as doing something.

Admittedly, it’s rare you’re faced with shooting a killer in cold blood to prevent him murdering a not-so-innocent man.

But sometimes the triadic nature of paediatric & adolescent medicine causes us trouble.

Take the dilemma posed in ADCE3 –

A young man of 14, post-pubertal, with a background of moderate learning disability is diagnosed with acute lymphoblastic leukaemia. His parents insist that you do not talk to him about gamete preservation options prior to chemotherapy, carries a moderate risk of subfertility. They explain that he wouldn’t be able to have his own family, and that their religious views see mastubation as an evil act.

Chemotherapy should begin within the next 72hrs or so, and parental support during the intensive – and prolonged (up to 3 years) therapy is vital.

How do you approach this situation?

• Archi