Involving Children in Medical Decisions – Harrison, Kenny, Sidarous and Rowell
Background: 11-year old Samantha had osteosarcoma in her left arm, which was amputated, she also
had to give up her pet cat to minimize her risk of infection. Later tests indicate that the cancer has
metastasized into her lungs and her chance of survival is 20%. Her parents want to continue with
treatment, Samantha doesn’t. Her physician, psychologist and psychiatrist decide that she’s not old
enough to make a competent decision.
Why Is It Important To Include Children In Medical Decision-Making?
Ethics: adults models (parents, physicans) presume that he patient is autonomous and has a stable sense
of self, established values, and mature cognitive skills; these characteristics are underdeveloped in
Although it’s important to understand and respect the developing autonomy of a child, and
although the duty of beneficence provides a starting point for determining what is in the child’s
best interest, a family-centered ethic is the best model for understanding the interdependent
relationships that beat upon the child’s situation.
A family-centered approach considers the effects of a decision on all family members, their
responsibilities toward one another, and the burdens and benefits of a decision for each
members, while acknowledging the special vulnerability of the child patient.
In the care of adults, the physician’s primary relationship is with the particular capable patient.
The patient’s family may be involved in decision-making, but it is usually the patient who
defines the bounds of such involvement.
The care of children, on the other hand, has been described in terms of a ‘triadic’ relationship in
which the child, their parents and the physician all have a necessary involvement.
It is more helpful to and respectful of the child to affirm the parents’ responsibility for the care
of their child while allowing the child to exercise choice in a measure appropriate to their level
of development and experience of illness and treatment.
This approach doesn’t discount the parents’ concerns and wishes, but recognizes the
child as the particular patient to whom the physician has a primary duty of care.
This approach seeks to harmonize the values of everyone involved in making the
Law: the legal right to refuse medical treatment is related to, but not identical with, the right to consent
Providing treatment despite a patient’s valid refusal can constitute battery and, in some
To be legally valid, the refusal of medical treatment must be given by a person deemed capable
of making health care choices, that is, capable of understanding the nature and consequences of
the recommended treatment, alternative treatments, and non-treatment.
When a child’s capacity is in doubt, an assessment is required.
In the case of children who are incapable of making their own health care decisions, parents or
legal guardians generally have the legal authority to act as surrogate decision-makers. The
surrogate decision-maker is obliged to make treatment decisions in the best interest of the child.
Policy: the Canadian Pediatric Society has no policy regarding the role of the child patient in decision-
making. While the American Academy of Pediatrics articulate the joint responsibility of physicians and
parents to make decisions for very young parents in their best interest and not exclude children and
adolescents from decision-making without pe