children

Question 1

what are possible value diversities between parents and healthcare professionals *

Answer 1

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

Question 2

what is the intrinsic power of autonomy *

Answer 2

that having the ability to make a decision, even if it is the wrong one, has power

Question 3

what is necessary for a child to be able to make an autonomous choice *

Answer 3

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

Question 4

describe how neurological development fits in with the ability of children to make autonomous decisions *

Answer 4

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

Question 5

describe respecting older children’s choices *

Answer 5

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

Question 6

what are the problem’s with children’s choices *

Answer 6

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

Question 7

explain children’s rights v paternalism *

Answer 7

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

Question 8

how do we define children’s best interests *

Answer 8

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

Question 9

describe the autonomy interest of children’s best interest (

Answer 9

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

Question 10

what happens when the factors of best interest contradict *

Answer 10

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

Question 11

what were the difficulties in the ashya case *

Answer 11

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

Question 12

what is the main focus of making decisions on behalf of children *

Answer 12

their best interest

Question 13

who decides what the child’s best interest is *

Answer 13

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

Question 14

what is the contribution of parental beliefs to decision making

Answer 14

each parent will bring own values and beliefs to decision

tehse might cause conflict with each other and health professionals

Question 15

describe the parental responsibility aspect of parental autonomy *

Answer 15

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

Question 16

problem with the concept of parental responsibility *

Answer 16

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

Question 17

so do parent’s have a responsibility to make decisions *

Answer 17

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

Question 18

explain the parental rights argument for parental autonomy *

Answer 18

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

Question 19

arguments against parental rights for parental autonomy *

Answer 19

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

Question 20

so do parent’s have a right to make decisions on behalf of their child *

Answer 20

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

Question 21

what do you do when drs agree and disagree - bring in case of ashya *

Answer 21

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

Question 22

examples of non-therapeutic interventions

Answer 22

religious circumcision

organ and tissue donation

non-therapeutic research

Question 23

what are the benefits of allowing children to donate tissue *

Answer 23

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

Question 24

what are the risks of involving children in tissue donation *

Answer 24

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

Question 25

so should we allow children to be tissue donors *

Answer 25

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

Question 26

summarise the dilemma of undergoing medical research in children *

Answer 26

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

Question 27

reasons why children should not be allowed to participate in non-therapeutic research *

Answer 27

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

Question 28

alturistic reasons why you would participate in research

Answer 28

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

Question 29

so should children be allowed to participate in non-therapeutic research *

Answer 29

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

Question 30

describe the hannah case regarding heart transplant

Answer 30

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