Parental Decision Making

I am enrolled with an online Continuing Education program for physicans, nurses and other health care practitioners. I thought the topic of Parental Decision Making would be appropriate to include here.

Please feel free to comment on or discuss this information as it pertains to JWs. While the case studies do not specifically refer to JWs, there are principles that apply related to the blood transfusion issue.

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http://www.medceu.com/course.cfm?CID=322

Parental Decision Making
Objectives: Upon completion of this course the participant will be able to demonstrate an understanding of the following:
Who has the authority to make decisions for children?
What is the basis for granting medical decision making authority to parents?
When can parental authority to make medical decisions for their children be challenged?
What if parents are unavailable and a child needs medical treatment?
Should children be involved in medical decisions even though their parents have final authority to make those decisions?
What happens when an older child disagrees with her parents about a medical treatment?
Under what circumstances can minors make medical decisions for themselves?
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Adult patients have the moral and legal right to make decisions about their own medical care. Because young children are not able to make complex decisions for themselves, the authority to make medical decisions on behalf of a child usually falls to the child's parents.
Who has the authority to make decisions for children?
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, parental 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 challenged.
What is the basis for granting medical decision making authority to parents?
In most cases, a child's parents are the persons who care the most about their child and know the most about him. As a result, parents are expected to make the best medical decisions for their children. Furthermore, since many medical decisions will also affect the child's family, parents can factor family issues and values into medical decisions about their children.
When can parental authority to make medical decisions for their children 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 harm 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 developmental 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 voice in medical decisions.
What happens when an older child disagrees with her 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 in question, 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 intractable cases, an ethics consultation or judicial hearing should be pursued.
Under what circumstances can minors make medical decisions for themselves?
Minors have the ethical and legal authority to make medical decisions for themselves when they have reached the legal age of majority or become "emancipated." Most states recognize an emancipated minor as a person who meets one of the following criteria:
* self-supporting and not living at home
* married
* pregnant
* a parent
* in the military
In addition, most states allow treatment without parental consent for sexually transmitted diseases, pregnancy, and drug or alcohol abuse.
Parental Decision Making:
Case 1
A 4-year-old with an obviously broken forearm is brought to the emergency department by her baby-sitter. Both the baby-sitter and emergency room staff have attempted to reach her parents without success.
Can you treat this child without parental permission?
Parental Decision Making:
Case 1 Discussion
Your first duty is to the health and welfare of the child. Having attempted to reach her parents for consent without success, you should proceed with x-rays and treatment of her fractured forearm. Rapid treatment of the child's pain and fracture are clearly in her best interest. When optimal treatment requires immediate intervention, treatment should not be delayed even if consent has not been obtained.
Parental Decision Making:
Case 2
An ill-appearing 2-year-old with a fever and stiff neck appears to have meningitis. His parents refuse a lumbar puncture on the grounds that they have heard spinal taps are extremely dangerous and painful.
What are your obligations in this case? How should you proceed?
Parental Decision Making:
Case 2 Discussion
A lumbar puncture is the only way to diagnose meningitis and a delay in treatment could cause significant harm to the child. Complications from the procedure are very rare, and the benefit in this case is likely to be substantial. There is not time to obtain an ethics consult or court order. The physician should attempt to address the parents' misconceptions about lumbar punctures and to reassure them about the safety of the procedure and perhaps offer to use appropriate pain control methods. A second opinion from another physician may prove helpful.
Should these efforts not result in parental permission, the physician is justified in proceeding with the procedure and treatment of the child. While parental authority to make medical decisions for their children is broad, it does not include choices that may seriously harm their children. As long as the physician has used reasonable clinical judgment in determining the need for the lumbar puncture, legal liability should be minimal.
Parental Decision Making:
Case 3
A 5-year-old child has just had his second generalized tonic-clonic seizure in a 4 month period. You have recommended starting an anticonvulsant. The parents have concerns about the recommended medication and would prefer to wait and see if their son has more seizures.
How should you respond to the parents request?
Parental Decision Making:
Case 3 Discussion
The parents have the authority to make a choice of this sort. In general, courts have been reluctant to overrule against parental wishes in most situations where that decision does not place the child at considerable risk. Though failure to start an anti-convulsant may increase the risk of further seizures, this does not pose a substantial enough risk to the child to justify overriding the parents' wishes, especially given the potential risks associated with the medication. Though you may not agree with their decision, the decision is a reasonable one that does not place their child at substantial risk of increased harm.

Parental Decision Making

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