Pediatric Ethics

Question 1

What is the driving standard for decision making for children?

Answer 1

Best interest of the child

*substituted judgement is not applicable

Question 2

General Rule: Minors (<18) do not have legal authority to make health care decisions (presumption of ______).

Answer 2

incompetence

Question 3

What are the 5 exceptions to parental decision making?

Answer 3

1) Emergencies
2) Parent is Estranged, Incapable (lack DMC), or Unwilling
3) Parents’ Decisions Put Child at Clear and Substantial Risk
4) Child is Mature or Emancipated Minor
5) Treatment of Specified Conditions

Question 4

What constitutes an emergency in treating a pediatric patient decision making?

Answer 4

Parent or guardian is not available and delay in treatment would jeopardize the child’s life or health.

Question 5

What are the situations where a minor can consent for him/herself without parental permission?

Answer 5

• Suicide prevention counseling
• Drug or alcohol dependency testing and treatment
• Sexually transmitted or communicable disease testing and treatment
• Pregnancy related treatment (except abortion) or treatment for their child

Question 6

Tell me about pediatric assent.

Answer 6

• Although generally children are not capable of giving informed consent for treatment, their assent to interventions is still ethically important. As they gain in maturity and decision making capacity, their involvement should grow
• It is disturbing to force interventions on children who are actively resisting them

Question 7

What are the four components of pediatric assent?

Answer 7

1) Help the minor achieve a developmentally appropriate awareness of his/her condition.
2) Tell the minor what he/she can expect.
3) Assess the minor’s understanding and factors influencing his/her response.
4) Solicit an expression of the minor’s willingness to accept treatment.

Question 8

Title X and Medicaid family planning services are ________ as a matter of federal law.

Answer 8

confidential

Question 9

You are caring for a 14 year old girl at a Planned Parenthood clinic in Texas whose mother requests to come into the examining room with her daughter. Of the following three, what is the most ethically appropriate response to the mother?

A. So long as the daughter does not strongly object, allow the mother’s presence since the daughter is legally incompetent to make decisions for herself.

B. Explain to the mother that you are legally and ethically prohibited from having the mother in the room since it would violate the daughter’s confidentiality.

C. Assess the risks and the benefits of the mother’s presence and upon determining whether you will permit the mother’s involvement make a note in the chart indicating your decision and assessment.

Answer 9

B. Explain to the mother that you are legally and ethically prohibited from having the mother in the room since it would violate the daughter’s confidentiality.

Question 10

Under what circumstances is it ethically justifiable to withhold information from an adolescent?

A. If disclosing the information would likely result in the adolescent declining treatment.

B. If disclosing the information would likely result in the adolescent declining a treatment that is life-sustaining

C. If disclosing the information would likely result in severe and immediate harm to self or others

D. It is never ethically justifiable to withhold information from an adolescent

Answer 10

C. If disclosing the information would likely result in severe and immediate harm to self or others