Children Healthcare Decisions, Who Has the Last

8/8/2019 Children Healthcare Decisions, Who Has the Last

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by:by:

AraliArali HerreraHerrera

JenniferJennifer OrmenoOrmeno

JoseJose BadilloBadillo..


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Healthcare decisions for Children,Healthcare decisions for Children,

who has the last word?who has the last word?


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When c n the p rents ecisi n king eWhen c n the p rents ecisi n king e

challenged?challenged?

y Medical caretakers have an ethical and legal duty toadvocate for the best interests of the child when

parental decisions are potentially dangerous to thechild's health, imprudent, neglectful, or abusive.When satisfactory resolution cannot be attainedthrough respectful discussion and ethics consultation,seeking a court order for appropriate care might benecessary.


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What if arents are unavailable and a childWhat if arents are unavailable and a child

needs medical treatment?needs medical treatment?

yWhen parents are not available to make decisionsabout a child's treatment, medical caretakers may

provide treatment necessary to prevent damage to thechild's health.


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Should children be involved in medical decisionsShould children be involved in medical decisions

even though their arents have final authority toeven though their arents have final authority to

make those decisions?make those decisions?

y Children with the ability to understand what ishappening to them should be allowed to participate in

discussions about their care. As children develop thecapacity to make decisions for themselves, they shouldbe given a choice in their medical decisions.


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What ha ens when an older child disagreesWhat ha ens when an older child disagrees

with her/his arents about a medicalwith her/his arents about a medical

treatment?treatment?

y The wishes of competent older children, regardingtheir medical care should be taken seriously. If the

medical caretaker judges a child competent to makethe medical decision , she should first attempt toresolve the issue through further discussion. If thatfails, the medical caretaker should assure that thechild's voice has been heard and advocate for the child.In non agreeable cases, an ethics consultation or

judicial hearing should be pursue.


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Case Study:Case Study:

Bioethics For Clinicians. Involving children inBioethics For Clinicians. Involving children in

medical decisionsmedical decisionsAn excerpt :

Eleven year oldSamantha is a bright, loving child who was treated for

osteosarcoma in her left arm. The arm had to be amputated, andSamantha was given a course of chemotherapy. She has been cancer freefor 18 months and is doing well in school. She is self-conscious about herprosthesis and sad because she had to give away her cat, Snowy, to decreaseher risk of infection. Recent tests indicate that the cancer has recurred andmetastasized to her lungs. Her family is devastated, but do not want to give up hope.

However, even with aggressive treatment Samanthas

chances for recovery are less than 20%.Samantha adamantly refuses further treatment. On earlier occasions she hasrefused 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 doyou want? Her parents insist that treatment must continue. (Harrison,C 825)


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AtWhat oint should Health Care workers steAtWhat oint should Health Care workers ste

in and say enough is enough?in and say enough is enough?

y In Texas, the rights of a parent are subject to courtorders, including an order granting a governmentalentity authority to consent to a child's medicaltreatment initially refused by the parents. Notably, inTexas, the courts and not the physician who has theright or obligation to seek court intervention, but theappropriate governmental agency, which the physician

must notify.T

herefore, the court concluded, a healthcare provider's obligation is generally to comply with apatient's (or parent's) refusal of medical treatmentuntil ordered by the court to do otherwise.


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How to Resolve this Case:How to Resolve this Case:

General Principles of decision Making

1. Appropriate Information - whether the decision

maker can make appropriate decision with sufficientinformation.

2. Decision- Making Capacity - the ability to receive,understand communication.

3. Involuntariness - the decision maker should not bemanipulated.


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General Princi les of Critical ThinkingGeneral Princi les of Critical Thinking

Critical thinking is a Multi-Dimensional

Skill.(Siddhartha,28)In an everyday situation nurses

will be faced with these ethicaldecisions.

All ethical decisions makingshould be interdisciplinary andcollaborative.


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.

Whether or not the child participates in theirWhether or not the child participates in theirhealthcare setting, the followinghealthcare setting, the following

considerations should bear upon a treatmentconsiderations should bear upon a treatmentdecision concerning a child and invasivedecision concerning a child and invasivetreatment.treatment.

The potential benefits to the child.The potential harmful consequences to the child,

including physical suffering, psychological or spiritual

distress and death.


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Conclusion To Case Study :Conclusion To Case Study :

y Samantha returns home, supported by a communitypalliative care program, and is allowed to have a new

kitten. She dies peacefully. (Harrison, 829)


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Conclusion For Health Care :Conclusion For Health Care :

y The primary concern of healthcare workers is thepatient's best interests.


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ReferencesReferences

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 BarAssociation,10. Retrieved from

http://www.hg.org/health-law.html

Suddarth, S, Brunner (2008). Textbook of Medical SurgicalNursing: eleventh edition. PA: Lippincott.

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Children Healthcare Decisions, Who Has the Last