Children Healthcare Decisions, Who Has

The Last Word ?

by:
Arali Herrera
Jennifer Ormeno
Jose Badillo.
 Healthcare decisions for Children,
who has the last word?

Adult patients have the moral and legal right to make decisions about their own medical
care. However, young children are not able to make complex decisions for themselves, the
authority to make medical decisions on behalf of a child usually falls on the child's parents.
Parents have the responsibility and authority to make medical decisions on behalf of their
children. This includes the right to refuse or discontinue treatments, even those that may be
life-sustaining. However, the parents decision making should be guided by the best interests
of the child. Decisions that are clearly not in a child's best interest can and should be
challenge legally.
 

 
When can the parents decision making be challenged?

Medical caretakers have an ethical and legal duty to

advocate for the best interests of the child when
parental decisions are potentially dangerous to the
child's health, imprudent, neglectful, or abusive.
When satisfactory resolution cannot be attained
through respectful discussion and ethics consultation,
seeking a court order for appropriate care might be
necessary.
What if parents are unavailable and a child needs medical treatment?
When parents are not available to make decisions
about a child's treatment, medical caretakers may
provide treatment necessary to prevent damage to the
child's health.
Should children be involved in medical decisions even though
their parents have final authority to make those decisions?
Children with the ability to understand what is
happening to them should be allowed to participate in
discussions about their care. As children develop the
capacity to make decisions for themselves, they should
be given a choice in their medical decisions.
What happens when an older child disagrees with her/his
parents about a medical treatment?
The wishes of competent older children, regarding
their medical care should be taken seriously. If the
medical caretaker judges a child competent to make
the medical decision , she should first attempt to
resolve the issue through further discussion. If that
fails, the medical caretaker should assure that the
child's voice has been heard and advocate for the child.
In non agreeable cases, an ethics consultation or
judicial hearing should be pursue.
Case Study:
Bioethics For Clinicians. Involving children in medical decisions
An excerpt :
 
Eleven year old
Samantha is a bright, loving child who was treated for
osteosarcoma in her left arm. The arm had to be amputated, and
Samantha was given a course of chemotherapy. She has been cancer free
for 18 months and is doing well in school. She is self-conscious about her
prosthesis and sad because she had to give away her cat, Snowy, to decrease
her risk of infection. Recent tests indicate that the cancer has recurred and
metastasized to her lungs. Her family is devastated, but do not want to give up hope. However, even
with aggressive treatment Samantha’s
chances for recovery are less than 20%.
Samantha adamantly refuses further treatment. On earlier occasions she has
refused treatment, only to struggle violently when it was administered.
She distrusts her health care providers and is angry with them and her parents.
She protests, “You already made me give up Snowy and my arm. What more do
you want?” Her parents insist that treatment must continue. (Harrison,C 825)
At What point should Health Care workers step in and say enough
is enough?
 In Texas, the rights of a parent are subject to court
orders, including an order granting a governmental
entity authority to consent to a child's medical
treatment initially refused by the parents. Notably, in
Texas, the courts and not the physician who has the
right or obligation to seek court intervention, but the
appropriate governmental agency, which the physician
must notify. Therefore, the court concluded, a health
care provider's obligation is generally to comply with a
patient's (or parent's) refusal of medical treatment until
ordered by the court to do otherwise.
How to Resolve this Case:

General Principles of decision Making

1. Appropriate Information - whether the decision
maker can make appropriate decision with sufficient
information.
2. Decision- Making Capacity - the ability to receive,
understand communication.
3. Involuntariness - the decision maker should not be
manipulated.
General Principles of Critical Thinking

Critical thinking is a Multi-

Dimensional Skill.
(Siddhartha,28)
In an everyday situation nurses
will be faced with these ethical
decisions.
All ethical decisions making
should be interdisciplinary and
collaborative.
 Whether or not the child participates in their
healthcare setting, the following
. considerations should bear upon a treatment
decision concerning a child and invasive
treatment.

• The potential benefits to the child.

• The potential harmful consequences to the child,
including physical suffering, psychological or spiritual
distress and death.
Conclusion To Case Study :

Samantha returns home, supported by a community

palliative care program, and is allowed to have a new
kitten. She dies peacefully. (Harrison, 829)
Conclusion For Health Care :

The primary concern of healthcare workers is the

patient's best interests.
 References

Harrison. C, PhD, Kenny, Nuala, Sidarous Mona, Rowell, Mary.

(1997). Involving Children
In Medical Decisons. Canadain Medical Association,9, 825-828
 
Manning,H. (1996). Bioethics For Beginners. American Bar
Association,10. Retrieved from
http://www.hg.org/health-law.html
 
Suddarth, S, Brunner (2008). Textbook of Medical Surgical
Nursing: eleventh edition. PA: Lippincott.