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Lecture 4

PHLB09 week 4 readings.docx

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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 children.  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 decision. Law: the legal right to refuse medical treatment is related to, but not identical with, the right to consent to treatment.  Providing treatment despite a patient’s valid refusal can constitute battery and, in some circumstances, negligence.  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
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