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Law > Children: Ethics > Flashcards

Children: Ethics Flashcards

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1
Q

What do autonomous choices require

A

Ability to understand information
Ability to form values

Ability to make decisions based on values and understanding of information without feeling under undue influence

Not everyone is capable of making autonomous choices
-this is decision specific, may be able to make autonomous choices on some decisions but not others

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2
Q

What is the value of autonomy

A

Instrumental value - promotes best interests

Intrinsic value - essential to human flourishing

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3
Q

Describe the value of respecting children’s choices

A

Children value being able to make decisions, even if they cannot make autonomous choices for all decisions

Older children and teenagers may be capable of autonomous decision making for the majority of decisions

They need to learn how to make decisions and understand the consequences to flourish as autonomous adults

Overriding a child’s choice risks promoting hostility and non-compliance

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4
Q

What are the problems with children’s choices

A

The ability to understand information increases with age

The ability to appreciate the impact of current decisions on the future increases with age

The ability to decide independently of parental and social influence increases with age

Values, aspirations, priorities and beliefs change with age

A child’s view of their best interests changes with time

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5
Q

Describe the child paternalist approach to child autonomy

A

Adult decision makers should make decisions on behalf if children on the basis of best interests

It is ethically appropriate to override a child’s autonomous decision if the decision if the decision is deemed not to be in that child’s best interests

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6
Q

Describe the child liberationist approach to child autonomy

A

Adults make bad decisions all the time

  • values, aspirations, priorities, beliefs of adults change over time
  • even as adults we often don’t appreciate the implication of our decisions for our future

Autonomous children have the same rights as autonomous adults

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7
Q

What are the 3 areas that make up best interests, according to John Eekelaar

A

Basic interests

  • promotion of physical, emotional care and wellbeing
  • ensure health, security, housing, feeding, clothing

Developmental interests

  • promoting personal development
  • education
  • socialisation
  • confidence and emotional maturity

Autonomy interests

  • promoting development of autonomy
  • respecting autonomous choices
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8
Q

How would you balance the 3 main interests

  • would this balance change in life-threatening circumstances
  • would this balance change with age
A

Basic, developmental and autonomy interests are necessary to ensure current wellbeing and development into an autonomous adult

Respecting autonomous choices will be crucial to this development

But if the choice results in death or serious harm => basic and developmental interests hold more importance as they are necessary to reaching adulthood

With age, increasing weight should be given to their autonomous choices

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9
Q

How would you balance best interests with autonomy

A

Overriding autonomy may fall in line with acting in a child’s overall best interests so they reach autonomous adulthood

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10
Q

The current law states that children become adults on their 18th birthday.
Once an adult, parents, doctors, and the Courts have no legal power to protect individuals from ‘bad decisions’

What’s are the arguments for and against having a cutoff for autonomous decisions

A
  • At a practical level, we need a legal cut-off
  • The law is not the only aspect protecting us from bad decisions
  • The development of physical, emotional and intellectual maturity continues beyond 18
  • Values and beliefs of adults continue to change with time
  • If we truly value autonomy, we have to allow people to make their own decisions
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11
Q

How would you approach best interests decisions for children who lack autonomy
-what are the difficulties in best interests decisions for a very young child

A

Babies, infants and young children - autonomy interests are not as important here as their basic and developmental interests

Basic Interests

  • burden of treatment
  • parental wishes

Overlap

  • parental values
  • health outcomes
  • impact on family
  • child’s wishes

Developmental interests
-impact on education and relationship with peers

Who decides what is in a child’s best interests if the values of the HCPs and parents differ?

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12
Q

What are the problems that arise when parents make decisions for their children

A

Do parents have the right to decide what should be done to their child

Or

Do parents have a responsibility to do what is best for their child

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13
Q

What are the arguments for parental best interests argument

-what are the counter arguments for this view?

A

Parents usually know their children better than anyone else and no one will love a child in the same way

Child welfare will be very relevant to the welfare of the family

Parents are best placed to decide what is in their child’s best interests

But

  • parents may be so emotionally involved that they cannot objectively weigh up the benefits and burdens of treatment
  • the personal views or beliefs of parents may lead them to consider effective treatments as unacceptable
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14
Q

What are the arguments for parental rights

-what are the counter arguments for this view

A

Individuals have a right to their own personal values and beliefs, we should respect the personal views and values of others

It is desirable for parents to share their values and beliefs with their children
We should not interfere with the decisions of parents provided they are motivated by the welfare of their children

But

  • individuals do not have the right to impose their own personal values and beliefs on others
  • parents have a duty to enable their children to reach autonomous adulthood
  • parents should not be able to martyr their children to their values and belief system
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15
Q

What are the potential problems with treatment

A

Whether a treatment is burdensome is an opinion
-with very young children, parents and doctors bring in their own perspectives to consider this

The pain and distress caused by treatment may be worse than inevitable death if withheld
The resulting quality of life may not be tolerable

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16
Q

What is needed when parents and doctors disagree

A

Both parents and doctors are concerned for the child’s welfare
But different values and beliefs result in differing assessments of welfare, harm, and benefit

Communication and reflection can help to improve trust and mutual understanding, making it easier to reach a compromise

17
Q

Are non-therapeutic medical procedures in the child’s best interests?
-what are some examples of non-therapeutic medical procedures

A

Tissue/organ donation

Medical research

18
Q

What are the risks and benefits of tissue donation for the child

A

Risks

  • physical harm to donor with no direct medical benefit
  • if transplant fails and the sibling dies, the child may grow up believing it was their fault
  • the best interests of one child may conflict against the best interests of the other

Benefits

  • altruism
  • save the life of their sibling
  • if the sibling dies because there was no donor, the child may grow up believing it was their fault
19
Q

What are the risks and benefits of medical research for the child

A

Risks

  • carries some risk
  • no direct medical benefit

Benefits
-altruistic

Although altruism is not the primary motivator for most adults participating in non-therapeutic research
Is altruism morally valuable if the child has no understanding of altruism?

20
Q

What is the current guidance on medical research on children

A

Research should carry minimal risk of harm

It is not possible to carry out the research in adults

The condition studied is specific to young children

Parental consent is obtained

21
Q

What is The Children Act 1989

  • S1.3
  • S1.5
  • when is the CA relevant to HCPs?
A

S1.3 - the child’s welfare is paramount
-the right of the parents is secondary to the child even if this creates an injust situation for either one or both of the parents

S1.5 - presumption of no order

  • the assumption that in most cases the courts will not force an order upon the parents of Local Authority
  • court orders will only be made where this will benefit the child
  • local authorities must work in partnership with parents for the welfare of the child

Obtaining consent
Refusal of treatment
Disclosure of information/breach of patient confidentiality

22
Q

What are the welfare principles of the Children Act in practice

  • children
  • parents
A

Children are

  • kept informed about what happens to them
  • have their wishes and feelings taken into account (considering their age and understanding)
  • have the opportunity to take part in decision making about their future
  • brought up and cared for within their families wherever possible
  • protected by effective interventions and kept safe if they are in danger

Parents

  • continue to have parental responsibility in relation to their children, even if they do not live with their children
  • are kept informed about their children
  • participate in decisions made about their future
  • with children in need should be helped to bring up their children themselves
  • work in partnership with agencies in a way that doesn’t prejudicee the welfare of the child
23
Q

Describe parental responsibility and how this relates to the Children Act 1989
-who can have parental responsibility

A

Parental responsibility gives either or both parents the right to decide for their children

The Children Act 1989 outlined how the courts would view matters when

  • relations between parents broke down
  • the Local Authority felt that the parents were not capable of looking after their children

Parental Responsibility

  • both parents if married at birth or both on birth certificate
  • mother only is unmarried and no agreement with father
  • legally appointed guardian
  • Local Authority with a care or protection order
24
Q

In what situation is the Local Authority obliged to intervene with the Children Act

A

Physical
Sexual
Neglect
Emotional abuse

Each authority is required to keep a list of those who are considered ‘at risk’

25
Q

What is the Family Law (Reform) Act 1969

A

States that the age of consent to medical treatment is 16

  • if U16, those with parental responsibility can consent for children
  • if there are many individuals with parental responsibility, it is ok to gain consent from only 1
  • if there is parental disagreement for major decisions => advisable to seek court approval
26
Q

What is the Gillick Exception

-what is the Fraser competence

A

Doctors can get consent for treatment from the child without consulting those with parental responsibility

There is no lower age limit but the younger the patient, the clinician will have to justify how the assessment of maturity and best interests was made

Fraser competence

  1. Ask the child if you can tell one or both parents
    - Yes => can be treated like other children with parental consent
    - No => confidentiality must be respected
  2. Assess their maturity regarding her treatment. Can they understand, retain, weigh up risks and benefits?
    - Yes => can be considered for the Gillick Exception if
  3. They are likely to suffer physical or mental harm without the treatment and it is in their BEST INTERESTS to receive it
27
Q

How does the Gillick Exception relate to refusal of treatment

A

Refusal of treatment is rarely in their BEST INTERESTS so unlikely to apply here

Parental responsibility ends at 18 so can overrule patient consent and ask the courts for permission if 16/17

If younger, permission from only 1 individual with parental responsibility is needed to proceed

28
Q

Is it always possible to act in the child’s best interests?

A

Something that is in a child’s best interests may not be in the best interests of others.
-this may also suggest that the best interests of others may have to be sacrificed for the child

May be more reasonable to expect that parental decisions should be motivated by concern for the welfare of their children and not be clearly against the interests of that child

Law (10 decks)

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