Chapter Three Flashcards
What is a minor?
anyone younger than 18 years of age
all medical procedures for minors require what?
- require parental or gurdian consent
- This means that anyone younger than 18 years of age needs someone older to act as a surrogate decision maker to assume responsibility for doing what is best for the minor
Historically what is the age of automony?
18
What is autonomy?
Autonomy is a person’s abil- ity to make decisions concerning his or her own personal business, including health care.
What happens when a minor does not have a parent?
If the minor does not have a parent, such as in the case of a child whose parents have died or a child in the custody of the state (as with foster care), the courts will appoint a guardian ad litem
What is a guardian ad litem?
- This person acts as the legal guardian for all decision-making processes, including decisions regarding health care.
- There are also cases where parents assume the role of guardian ad litem for disabled children after they reach the age of majority or for their elderly parents who are no longer considered competent.
Reasonable and rational parents (or guardians) base their healthcare on what?
- base their healthcare deci- sions on family values, resources, and needs.
- Not all families will make the same decisions, because they have different values, different financial resources, and different needs.
What is the the duty of healthcare professionals?
- As healthcare professionals, our duty is to explain the various choices available and respect decisions made—regardless of personal opinions.
- We might not always agree with a family’s decisions, but our role is to advise, not judge
why might there be conflict between healthcare professional and families? What is an example
- A healthcare professional will sometimes feel that family decisions conflict with the best interests of the child.
- These instances may result from religious and cultural differences, and may involve minors who are facing an untimely death.
- Certain religions and cultures have strict guidelines regarding medical issues.
- For example, families that practice Jehovah’s Witness see blood transfusions as a violation of their religious practice
What does jehovah witness believe?
- believes that any blood that leaves one body should not be placed in another body and, further, that any blood that leaves the body should be discarded. Jehovah’s Witnesses will accept other types of fluid infusion, such as medications, just not blood.
- To follow this type of religious policy is an acceptable decision for an informed adult, but withholding a lifesaving procedure from a minor because of parental religious convictions is generally found to be an ethical and legal dilemma.
What happen in the prince v. common wealth of massachusetts case?
The court based the decision on the 1944 Supreme Court case of Prince v . Commonwealth of Massachusetts . In that case, the courts ruled that “[t]he right to practice religion freely does not include the liberty to expose . . . a child . . . to ill health or death . Parents may be free to become martyrs themselves . But it does not follow that they are free . . . to make martyrs of their children before the children reach the age of full and legal discretion when they can make the choice for themselves” (Prince v. Commonwealth of Massachusetts, 1944) .
What does the case of johnny illustrate?
healthcare professionals occasionally need to consult the legal system when there are conflicts between the decisions of the par- ents and what the medical community considers to be in the best interest of the child.
What is another know medical controverisal issue around children?
- For instance, due to religious or personal reasons, some parents might refuse to allow their child to become vaccinated.
- Most states require children to be fully vaccinated before they can enter the public school system, but parents with religious or secular convictions can opt out of this requirement in some states.
- The controversy around this issue continues as some parents who opted out due to concerns that vaccinations might be linked to development disorders, such as autism, learn that the research was fraudulent.
- In California, a measles outbreak resulted in legislation limiting vaccination exemptions to those with medical reasons (SB-277, 2016).
What happened in the phillips v. city of New york, 2015 court case?
- Two families in the state of New York challenged a law requiring vaccinations for public school students .
- The families cited exemption due to religious differences .
- The case started when the children were not allowed to attend school during a chicken pox outbreak because they were not vaccinated .
- The parents claimed it was a violation of their constitutional rights .
- The 2nd Circuit Court of Appeals dismissed the claim stating that their arguments were invalid (Phillips v. City of New York, 2015) .
If a woman goes into labor early, how does the medical community decide which procedures are helpful and which are harmful?
- A premature infant born at less than 23 weeks’ gestation is generally not resuscitated because the medical community agrees that quality of life for the infant would be poor.
- After 25 weeks, aggressive measures are taken to resuscitate the newborn.
- Between 23 and 25 weeks, the decision is left up to the parents and medical community based on various factors, including overall health of the newborn, trauma of the birth process, and resources of the family
- Asking parents to provide informed consent at this stage is problematic because of traumatic outcomes that are difficult to predict. The parents are asked to either give up a future child or face the possibility of raising a child with develop- mental and medical difficulties
Who was gregory messenger?
In Michigan, a man was accused of manslaughter after removing his son from a respirator that was preserving the premature infant’s life . Gregory Messenger and his wife were concerned that the baby, who was born 15 weeks premature, would have severe brain damage . The infant had been given a 50% chance of survival at the time of birth . Messenger and his wife had told doctors not to place the infant on life support, but the doctor in charge ordered a respirator to be used if the infant was active after delivery . Messenger was acquitted
In other cases, the parent or guardian might have a difficult time making decisions regarding options for their minor, especially when a minor requires life support. Making the decision to withdraw or withhold life support is never easy for a parent. What might the healthcare professionals might ask to do?
may be asked to provide guidance when it comes to this type of decision. It is always important to consider several factors, including the reason for the life support (e.g., tragic accident v. chronic illness).
At what age do minors have the capacity to make their own decisions?
The answer varies from state to state and depends on cer- tain variables, such as chosen procedures, medical conditions, and compliance with privacy laws.
What do most states consider someone incapable?
most states consider anyone 12 years of age and younger incapable of making informed medical decisions
What does title X do?
For example, many states allow minors to obtain contraceptives and prenatal care without parental consent or notification. Title X (10), a federal family planning program, specifically provides these ser- vices to minors
How do most states handle an abortion with minor?
- however, laws require parental consent and/or noti- fication of at least one parent before a minor can have an abortion
- The U.S. Supreme Court does grant minors a limited amount of privacy when it comes to abortion procedures.
- The recognition of this privacy allows for courts to bypass parental consent if it is decided that the minor is mature enough and under- stands the risks involved.
What are other cicumstances that allow for a waiver of parental consent for minors?
- These include emergency situations in which it is assumed the parents would pro- vide consent, sexual abuse instances where the parent is suspected to be involved in the abuse, and mental health or substance abuse services (minors can seek treatment without notifying parents).
- most states allow anyone older than 12 years of age to be tested and treated for sexually transmitted diseases, including HIV, without parental notification or consent
- Some states do require notifica- tion, and some states restrict the treatment allowed without parental consent
When are minors better suited to make medical decisions?
- minors with a chronic illness are often better suited to make medical decisions because of their experience.
- However, it is also important to consider the other factors, including stage of development, cogni- tive and emotional ability, and environment.
What is the mature minor doctrine?
- provides greater autonomy to minors older than 16 years of age who understand and consent to relatively simple medical procedures. This doctrine is a legal concept used by the courts, but a few states have passed it as a statut
- Even if healthcare professionals consider these fac- tors and believe a minor to be able to provide informed consent, the parents might not agree. If parents and minors do not agree on the course of medical action to be taken, the legal system may be called upon to intervene.
What happened with starchild abraham cherrix?
Sixteen-year-old Starchild Abraham Cherrix was diagnosed with Hodgkin’s disease . After an initial regimen of chemotherapy, he refused any further treatments, stating that he wished to try alternative medicine instead . His parents supported this decision, which led to an accusation of neglect . A juvenile court found Cherrix’s parents guilty of medical neglect and required that he return to conventional treatment . An appeal to a circuit court resulted in a reverse of this decision and allowed Cherrix and his family to work with an oncologist (a doctor specializing in cancer treatments) interested in alternative cancer treatments (Hester, n .d .) . After this case was settled, the state of Virginia added Abraham’s Law to permit parents to “refuse medical treatment or to choose alternative treatments for children aged 14 to 17 with a life-threatening medical condition, if the teenager seems to be mature, both the parents and the child have considered the treatment options available to them, and all agree that their choice is in the child’s best interest” (63 .2–100 of the Code of Virginia) .