children Flashcards
what are possible value diversities between parents and healthcare professionals *
parents might have hugher value of the SE of treatment and so be reluctant for the pt to have it
dr have higher value of the prospect of survival of the treatment
they disagree what the best interests of the child are
what is the intrinsic power of autonomy *
that having the ability to make a decision, even if it is the wrong one, has power
what is necessary for a child to be able to make an autonomous choice *
they need to be able to:
understand the information
be able to formulate views in order to weigh up info
be able to make a decision w/o feeling under undue influence
describe how neurological development fits in with the ability of children to make autonomous decisions *
different parts of the brain develop at different times - the prefrontal cortex develops late - functional by the age of 4, fine tuning of PFC continues to develop into adolescence
prefrontal cortex controls: planning and reasoning, inhib control
myelination continues into adolescence so cant control, plan or make stable decisions, you are impulsive
describe respecting older children’s choices *
depending on the decision and the maturity of the child, chuldren will usually meet the critera for autonomous decision making between age 8-15 - ie way uo QOL and life expectancy
teenagers and older children may meet the criteria for autonomous decision making but may make unwise decisions - however we would never overrule adults choice if we thought it was unwise so what gives us the right to overrule children
what are the problem’s with children’s choices *
cognitive ability - does the child fully inderstand the impact of their decisions - this develops with age
psychological maturity - does the child feel pressured to make decisions
values beliefs and aspirations - will they want the same thing in 10years
explain children’s rights v paternalism *
should children who are autonomous make decisions same as adults - adults make bad decisions; their values, aspirations, priorites and beliefs change over time
even as adults we dont appreciate the implications of our decisions on future lives
how do we define children’s best interests *
John eekelaar proposed that we have to promote their basic interests, developmental interests and autonomy interests
basic - the findamentals of life - central to the child’s wellbeing ie promotion of the child’s physical emotional and interlectual care eg health, security, housing, feeding and clothing
developmental- interests that a child has to enable them to develop as a person eg interetes in eductation, socialisation, confidence, and educational maturity
autonomy - interests that children have in being permitted to make decisions for themselves, respecting autonomous choices
describe the autonomy interest of children’s best interest (
even young children value being able to make decisions
children need to learn to make decisions and understand their consequences if they are flourish as autonomous adults
overriding a child’s choice/decision risks promoting hostility and non-compliance
what happens when the factors of best interest contradict *
basic, developmental and autonomy interests ensure current wellbeing and development into an autonomous adult
respecting autonomous decisions will be crucial to this
but sometimes the choice may result in death or serious harm - then basic and developmental interests take precedence - they are necessary to reaching adulthood - therefore overriing autonomy will be in the child’s best interests
as a child matures - increasing weight should be given to autonomous decisions - it is less likely that overriding their decisions will be in their best interest
what were the difficulties in the ashya case *
parental beliefs and values
parental autonomy - the fact that parents should be given the decision even if bad is fundamentally important
dr had duty to act in pts best interests
dr had to think about fair resource allocation
what is the main focus of making decisions on behalf of children *
their best interest
who decides what the child’s best interest is *
the problem is that what the best interest is is a matter of value not fact
so parents and drs may have different perspectives on what constitues best interests
parents have to look after the chuild even if given the treatment taht they didnt want and this caused SE - would he have to go into care- comprimise his best interest
adults value their lives and can determine the significance of discomfort or pain of treatment - with young children drs and parents bring their perspectives to weigh up values - who can decide if the distress is worth the treatment
what is the contribution of parental beliefs to decision making
each parent will bring own values and beliefs to decision
tehse might cause conflict with each other and health professionals
describe the parental responsibility aspect of parental autonomy *
parents know their children better than anyone else eg know how they will respond to pain
no one will love a child the same way a parent does
welfare of the family will be relevant to welfare of the child
so parents are best placed to decide what is in their best interest
problem with the concept of parental responsibility *
they may be emotionally involved so they cannot weigh up objectively the benefits and burdens of the treatment - cling to the slightest idea of hope
the personal views or beliefs of parents may lead them to consider effective treatments as unacceptible
parent’s views may be irrational eg vaccination
so do parent’s have a responsibility to make decisions *
only when in the child’s best interest
if unreasonable their decision may be overriden
but only if it causes significant harm - so there are a range of choices pts can make
explain the parental rights argument for parental autonomy *
individuals have their own personal values and beliefs
respect for autonomy means we should respect the personal views and values of others - eg natural/unconventional medical therapy
it is desirable for parenyts to share their values and belief system with their children
therefore we should not interfere with the decisions of parents - provided they are motivated by the care of their children eg in infection we dont interefere because the parents are motivated by protecting their child
arguments against parental rights for parental autonomy *
individuals dont have a right to impose their own personal values on beliefs of others
autonomy can be overridden if it harms others
we dont stop giving blood to jehovener’s witnesses if pt is going to die
so do parent’s have a right to make decisions on behalf of their child *
parental decisions should be respected unless clearly detrimental to the child’s future autonomy
therefore parents should not be able to martyr their children to their value and belief system
what do you do when drs agree and disagree - bring in case of ashya *
generally parents and drs share same primary concern - teh child’s welfare
however differening values and beliefs ;ead to different assessments of welfare, harm and benefit
good communication and reflection is likely to improve trust and mutual understanding making it easier to reach an agreed way forward
ashya - father believed he would be removed and treatment would not be in the pts best interest - when this trust was broken down it makes it difficult to make decisions - make sure people feel listened to
examples of non-therapeutic interventions
religious circumcision
organ and tissue donation
non-therapeutic research
what are the benefits of allowing children to donate tissue *
alturism - they feel as if they had done good - there is value to this
save the life of a sibling
if sibling dies because there was no donor - the child may grow up believeing it was their fault
what are the risks of involving children in tissue donation *
physical harm to donor with no direct benefit - have to go under general anaesthetic and pain
if the transplant fails and sibling dies - child may grow up believing it is their fault
so should we allow children to be tissue donors *
have to proove that it is in the child’s best interest
difficult to proove when half siblings so live apart so have no effect on child’s life - probably not allowed in this case because not in child’s best interest
summarise the dilemma of undergoing medical research in children *
progress in paeds is limited by the difficulty in recruiting and carrying out paediatric research
todays children benefit from previous research involving children - therefore could be argued that they are allowed to participate in current research
eg research programs in leukaemia in last 40 years have increased survival from 5-80%
there are small risks and a huge societal benefit
reasons why children should not be allowed to participate in non-therapeutic research *
we do not consider adults to have a duty to participate in medical research
adult participation in rsearch is voluntary
adults understand the purpose and risks - children dont
alturism is not the primary motivator for most adults participating in non-therapeutic research - even if it was it is arguably not viable if the child has no understanding of alturism
alturistic reasons why you would participate in research
To help future patients
To help advance medical science
To receive medical benefits
To get a specific medical treatment
To get extra attention
I felt I had little choice
I trust the study doctor
I trust this hospital
To maintain hope
so should children be allowed to participate in non-therapeutic research *
it should not be imposed on children more than it should on adults
it can onky be done if it could not be done on a less vulnerable group
if there is no benefit to the child then the risk should be minimal
parents and children must not feel pressured
describe the hannah case regarding heart transplant
she had autonomy to decide that she didnt want it because she didnt want to spend anymore time in the hospital - she had the capacity to do this and her decision was autonomous so she didnt get it
later she changed her mind and got it
