Parental Medical Decision Making: In Whose Best Interest?
I indicated in my last post that the in evaluating the ethics of the parental medical decision-making scenarios I presented, the goal would be in terms of the best interest with regard to the child patient. However, this goal may not be the most realistic and most just in this situation.
A 1985 article in the Journal of Medical Philosophy (vol. 10, nr 1, pages 45-61 ) titled ”Parental discretion and children's rights: background and implications for medical decision-making.” by F. Schoeman raises the issue of in whose best interest should parental decision making for their children be considered appropriate by law and society—only that of the child involved or of the child, parents and the family as a whole. The abstract of the paper is as follows:
”This paper argues that liberal tenets that justify intervention to promote the welfare of an incompetent do not suffice as a basis for analyzing parent-child relationships, and that this inadequacy is the basis for many of the problems that arise when thinking about the state's role in resolving family conflicts, particularly when monitoring parental discretion in medical decision-making on behalf of a child. The state may be limited by the best interest criterion when dealing with children, but parents are not. The state's relation with the child is formal while the parental relation is intimate, having its own goals and purposes. While the liberal canons insist on the incompetent one's best interest, parents are permitted to compromise the child's interest for ends related to these familial goals and purposes. Parents decisions should be supervened, in general, only if it can be shown that no responsible mode of thinking warrants such treatment of a child.”
Do you agree that parents who make medical decisions for their child also have the responsibility to consider the decision in terms of their entire family and not solely in what is in their sick child's best interest? How should possible conflicts of interest in this situation be evaluated and handled? ..Maurice.
posted by Maurice Bernstein, M.D. @ 8:52:00 PM
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1 Comments:
Appropriate decision making should be determined in the best interest of the child by understanding the child’s viewpoint. Traditionally the parents are the true decision makers on behalf of the child, even though the parents may not always have the child’s best interest because of their own views, moral positions and religious beliefs. Between these views, there can be many conflicts that can arise between the parents, the child and the doctors. The parents should know best for their child and can probably get a true answer or initiative on how the child feels and what he or she wants to carry out. In the Garrison and Schneider book, it quotes, “Unlike parents, judges will never have the time or day-to-day contact necessary to acquire an intimate understanding of the procession of children who would come before them. Nor will they have to live with the many-faceted ramifications of their childrearing decisions…” (p. 557). People should respect the child’s autonomy by letting the child to be able to participate in their own decision making. Parents and health care providers should make an effort to pay attention to and respect the child to correspond, verbally or nonverbally about their own treatment preferences. A child with full decisional capability has the right to make any decisions about their treatment or non-treatment.
The decision making can be very challenging for a child in certain types of situations, but the child should have an understanding of his or her illness or disease. The child should know about the positive and negative effects of the treatment, the consequences and what will happen later in the future when the treatments are over and the child is an adult. The child should make a decision on his or her own values and should be able to communicate with their parents.
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