Medical decision-making in paediatrics: Infancy to adolescence

Question 1

What are the 3 components of informed consent?

Answer 1

1. Has capacity to make the decision
   - “the patient’s ability to understand information relevant to a treatment decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision”
2. Adequately informed
   - given all information that a reasonable person would need to require to make a decision
3. Decision must be voluntary and free of coercion
   - voluntariness of pediatric patient’s decision come into question because:
4. relatively limited life experience
5. dependence on parents
6. emerging sense of self

Question 2

what is “minimum standard of acceptable care”

Answer 2

treatment course that is beneficial, needed to maintain life or health in a pediatric patient and below which a SDM is not permitted to act

Question 3

what is an emancipated minor?

Answer 3

adolescents living independently from guardians or who are parents themselves

Question 4

what is a mature minor?

Answer 4

adolescents who have demonstrated decision making abilities
“capable of fully appreciating the nature and consequences of medical treatment and can give legally effective consent”

legally not an adult according to chronological age criteria but has cognitive ability to consider treatment choices and alternatives and weigh the consequences

Question 5

what is assent?

Answer 5

providing agreement when full consent is not possible (lacks one of 3 main elements)

Question 6

Is the authority of substitute decision makers absolute?

Answer 6

o Decision-making authority limited to interventions deemed to be medically necessary
o If not medical necessity or if treatment involves personal preference, intervention should be deferred until individuals are capable of choice
• Must act in accordance of previously expressed wishes of a prior capable patient

Question 7

What are the 3 factors of the Best Interests Standard?

Answer 7

1. Maximize benefits and minimize burden
2. Must meet minimum acceptable threshold of care (judged by Reasonable Person Standard)
3. SDM must act in accordance with accepted moral and legal duties to their ward

Question 8

What are the 3 indications that withholding/withdrawing life sustaining interventions milestone is reached?

Answer 8

• progression to death imminent/irreversible
• interventions ineffective or likely to result in harm>benefit
• intervention prolong dying process and discontinuing would allow better palliative care