Involvement of family members in the healthcare decisions for children is a debatable issue. Parents’ engaged in the decision-making of their child’s health care, poses challenges to the American bioethical system, which regards the patient sovereignty as the fundamental ethical principle in the medical decision making policy .
American Academy of Pediatrics (AAP) has established certain recommendations pertaining to the child’s decision-making and categorizes children based on their level of maturity and decision-making ability into three groups: those that lack the ability to take decisions, those with a premature developing capacity and those that are mature enough to make decisions on their own. AAP recommends that parents should make the final decisions for children without the decision-making abilities, unless these are detrimental or careless. For children with immature or developing capacity, the physician should obtain parental as well as child’s consent. AAP also recommends that in case of parent-child conflicts, a third-party arbitration should be obtained. In case of children that possess decision-making aptitudes, the AAP establishes children’s informed consent is mandatory and their parents should be regarded as consultants .
While these guidelines may seem pragmatic and logical, they lack the justification and explanation for the definition of a child’s maturity and decision-making capacity. Absence of any established criteria for the definition and assessment of these capabilities, automatically assigns the authority of judgment to a pediatrician, who may not even be trained to make such an evaluation . The capacity to make important decisions in childhood and adolescence is associated with cognitive and emotional developmental milestones, just as there are anticipated milestones for physical development .
In case of a conflict between the parent and child, regarding their healthcare decision, a competent child is given the complete authority to make healthcare decisions . Competency, however, may be considered as an essential but inadequate quality for determining a minor individual’s. There are, currently, no diagnostic tests to quantify competency and differentiate between competent and non-competent individuals. Designing such tests is challenging, considering that competency is a subjective quality and depends on many factors such as cultural background.
Role of Parents
Many ethicists believe that there are practical reasons for allowing the parents to supersede the sovereignty of competent children . Parents would be the best judges of their children’s capabilities and potential in their health care decision-making. They have consigned interest in their children’s overall betterment and take critical decisions for their development. Besides, children have restricted knowledge and experience of worldly matters and hence their decisions would lack an understanding of what is right for them . The majority of the children lack the capacity for making health care decisions and require a substitute to make these choices.
It is also important to regard a mature child’s involvement in the decision-making process. Children should be made aware about the diagnostic methods and treatment options, prior to any intervention . While it is of utmost importance to engage the children actively in the decision-making procedure and teach them how to make crucial decisions, it is ethically appropriate to confer upon the parents, the ultimate authority to take final decisions related to their child’s care.
Third Party involvement in decision-making process
Engagement of third parties such as physicians in the child’s health care decisions is controversial, typically because it may undermine the right and privilege of the parents to make sound medical choices for their children. While physicians serve as temporary providers of medical care, parents have the ultimate responsibility of bringing up their children and making them independent decision makers, as adults .
In some cases, however, ethical dilemma may arise when health care professionals prescribe treatment options that are detrimental to the moral, ethical and religious ideas and beliefs of the parents. Such decisions could be extremely unfavorable and burdensome to the bond between a child and his family . Also, in some cases, the parents may turn down some treatments for their children, owing to their religious beliefs, in which case the legal interventions of the healthcare professionals may be in the best interest for the children. For instance, the followers of Christianity reject all medical treatment options and adopt spiritual and healing practices such as prayers to God and use of anointments. Scientific reports have demonstrated the effect of such extremist religious beliefs and refusal to treatments on mortality of infants and children, due to easily curable diseases such as diabetes and pneumonia . Although a due regard for parental autonomy in child health care is a critical ethical principle, it is crucial for health care providers to report incidents of medical carelessness. In such circumstances, the law needs to override the parental religious refusals and order for medical treatments that can save lives. The right to follow one’s religion does not authorize the parents to misuse their autonomy and jeopardize the lives and well-being of their children and the community, as a whole .
Works Cited
Antommaria, A, Weise, K L. "Conflicts Between Religious or Spiritual Beliefs and Pediatric Care: Informed Refusal, Exemptions, and Public Funding." Pediatrics (2013): 132 (5).
Macina, R P. "Healthcare Decisions in Minors." The Journal of Lancaster General Hospital (2007): 2 (1): 1-26.
Ross, L F. "Healthcare Decision making by children- is it in their interest?" The Hasting Centre Report (1997): 41 (5).
"Treatment decisions regarding infants, children and adolescents." Paediatr Child Health (2004): 9(2): 99–103.
