Class #7 - Ethics in pediatrics

Question 1

Canadian Pediatric Society Position Statement regarding child treatments?

Answer 1

In most case parents are appropriate decision makers, they should give priority to child best interest.
Unless its obvious the decision is not in the child best interest

Question 2

Criteria’s to determine therapies?

Answer 2

1. Child best interest

2. Benefits vs burdens

Question 3

Nursing challenge?

Answer 3

Child voice in decision

Question 4

once child/ado has enough decision making capacity?

Answer 4

They should be principal decision maker.

Question 5

Law regarding minors consent?

Answer 5

under 14 years old = tutor/parental authority

Over 14 years old = consent alone, but if in establishment over 12 hours, tutor should be informed

Question 6

College of Physisans of ON policy statements?

Answer 6

If minor capable to consent, they should directly consent even of accompanied by parents.

Question 7

Capacity def?

Answer 7

Capacity: Capable of understanding information relevant to decision making and able to foresee consequence of decision.

Question 8

Presumption of capacity def?

Answer 8

Presumed to be capable with respect with the treatments.

Question 9

So capacity depends on?

Answer 9

The treatments and its complexity to understand its consequences

Question 10

When deciding an incapable persons best interest, the decision-maker should base his decision on?

Answer 10

1. Values/beliefs of person she held before becoming incapable
2. Any wishes expressed when capable
3. Factors :
4. 1.1 - Treatment likely to: IMPROVE well-being/condition
5. 1.2 - Treatment likely to: PREVENT well-being/condition deterioration
6. 1.3 - Treatment likely to: REDUCE rate of well-being/condition deterioration
7. 2 - Condition likely to improve,remains the same or deteriorate w/o treat.
8. 3 - Benefits outweighs risks of harm
9. 4 - Whether a less invasive treatment would be as beneficial

Question 11

Exception for parental consent?

Answer 11

1. Mature minor
2. Emancipated minor = with adults right (eg. married)
3. ER treatment
4. Court ordered treatment

Question 12

Assent=?

Answer 12

Expressing Approval

Question 13

Assent implies?

Answer 13

1. Optimize child understanding

2. Seeking child voluntary cooperation

Question 14

Exceptions to confidentiality?

Answer 14

1. Client consent (autonomy)
2. Court order
3. Statutory duty
4. Public interest

Question 15

Conditions for disclosure (3) with the extent?

Answer 15

Clear risk to identifiable person
Serious risk of harm
Imminent danger

extent = limited in proportion to imminent risk

Question 16

Exception to DUTY to provide life-substaining treatment? needs consensus in (4) aspects.

Answer 16

1. Irreversible imminent death
2. Treatment clearly ineffective
3. Limitations allows greater palliative care
4. Unpreventable suffering

Question 17

Withdrawing Artificial NUtrition and Hydratation (ANH) legally and ethically permissible?

Answer 17

YES

Question 18

What is double effect?

Answer 18

Actions has both good and bad consequences. (eg. Rx that may shorten life)

Question 19

Double effect 4 principles?

Answer 19

1. Nature of act either good or morally neutral
2. Intention is for good effect
3. Good outweigh bad, situation merits risk of bad effect.
4. The bad is not used to achieve good (eg. death to stop suffering)

Question 20

QC right to end-of -life care about legalizing medical aid in dying for peds?

Answer 20

only majority