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37 Cards in this Set
- Front
- Back
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Are children Autonomous?
as in are they able to make their own decisions? |
Children are not autonomous
Incapable of making informed decisions Parents are presumed to be the appropriate decision makers They must be protected from consequences of unwise decisions |
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Who makes the choice for the children?
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the parents.....but
Physicians should be advocates for children Identify situations in which a child may be jeopardized |
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How are kids different....
Physicians should respect their potential to become autonomous adults |
Children mature and may chose values that differ from their parents values
As they are able to make more informed decisions, their involvement in their care should increase Inform kids to the extent it is developmentally appropriate |
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kids deserve a right to know what they have....
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they are smarter then you think :)
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What is most importance for making choices in children?
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Autonomy is less important in children than in adults, and beneficence becomes more paramount
****EXAM know BENEFICENCE |
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How do you value children's preferences?
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Respect informed decisions by children to the extent in which they can make them
Avoid “forced therapy” |
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Who should make medical decisions
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Parents are presumed to be the appropriate decision makers for their children
Within American society, parents have the discretion to inculcate their values in children and to make rearing decisions |
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Who should make medical decisions
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Pediatricians seek parental permission rather than consent
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Can a parent refuse tx for a child?
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Although informed adults have a right to refuse any medical treatment, parents do not have absolute power to refuse care for their children
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What if a child is developmentally appropriate?
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Parental permission should have the child’s assent when developmentally appropriate
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What if an emergency occurs and no parent is around?
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When a parent/guardian is not available & a delay in treatment would jeopardize the children, the physician should immediately provide treatment without waiting for parental permission
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What are exceptions to parental decision making?
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Exceptions to Parental Decision Making:
Parents lack capacity to make informed decisions Court appointed guardian |
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What is the age to medical decsions?
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Most states say that 18 years of age is the age of consent
Exceptions to this, including sexual & psychiatric health issues |
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What about birth control?
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age is 16
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What about psychiatric issues?
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age is 16
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What about STDs?
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age is 16
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What is a Mature Minor?
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Capable of giving informed consent
“a person <18 yo who has been determined by a qualified physician (one who has seen the patient), a qualified psychologist or an advanced nurse practitioner in collaboration with a physician to have capacity to make health care decisions” In most states, the courts must also declare this |
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What is an emancipated minor?
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“A person over age 16 yo who has been declared emancipated (independent of their parents) by a judge or who is over age 16 yo and is married”
Usually living apart from their parents, managing their own finances, have children, or have served in the armed forces Most states require a declaration by the courts |
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What are specialized conditions?
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Most states allow minors to assent to treatment without parental permission for sensitive conditions
STDs, contraception, pregnancy, sexual assault Substance abuse Psychiatric illness |
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What if a parent wants you to test a child for a drugs? ....What do you do?
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Parents may request that you test for illicit drug use or pregnancy without telling the child
Although the parents are concerned, doing so violates their emerging autonomy, creates mistrust and suspicion within the family, and undermines the trust in the physician |
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What about disclosure of information in children?
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Children usually cope better, have fewer psychosocial problems, and adhere more closely to treatment if they understand their diagnosis and proposed therapy
Never promise that the child will not learn the diagnosis |
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What are 3 exceptions for confidentiality?
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Obligate reports for child abuse and neglect
Do not need definitive proof, only sufficient information to warrant a fuller investigation My need to disclose to schools Don’t have to give diagnosis, just that is medically necessary Adolescent confidentiality for sensitive issues Can help them discuss with their parents if they wish |
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The interests of the pregnant woman and the fetus are intertwined
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One patient model v Two patient model
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What about informed consent and baby?
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Informed consent cannot be waived because the woman is pregnant
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Provision of information about family planning and abortion
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Some have strong moral and religious objections to these interventions
Institutions should make reasonable accommodations to conscientious objections and patients should be referred to facilities that provide care |
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< 18 may seek care for contraception, STDs and pregnancy
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Most states allow access reproductive health care without parental consent rather than forgo it because they are reluctant or unable to get parental consent
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Prenatal Testing
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OBs routinely screen for multiple diseases
Usually pregnant women assent to routine testing, without full informed consent for each test Justifications for testing: Prevention of harm for children who will be born Poor uptake of voluntary testing Judgment that infringement of the woman’s autonomy is acceptable |
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Obstetric Emergencies
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As with any emergency, informed consent may be truncated if delaying care would cause serious harm & if most patients would agree if fully informed
Almost all pregnant women agree to recommended emergency cesarean sections |
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Sterilization
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Sterilization without consent is a grave violation of autonomy
Historically was performed on disadvantaged women Many states have procedural requirements, such as waiting times to ensure these procedures are voluntary and informed |
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What is prolife?
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Pro-life advocates that the fetus is a person with a right to live and that abortion constitutes a form of murder
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What is prochoice?
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Pro-choice advocates that a woman has a right to control her body and their reproductive choices
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Have to know the cases on EXAM***
Abortions |
Planned Parenthood v. Casey (1992) – Supreme Court affirmed the landmark:
1973 Roe v. Wade which protected a woman’s right to chose to abort her fetus |
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If you don't want to do an abortion do you have to do one?
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Remember that laws and ethics are different, and one is never legally or obligated to perform an abortion
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Who decides if a child should be screened for a genetic abnormality?
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Now recommended that the various options for screening be offered to all pregnant women, regardless of age
Women vary in their desire for information about the fetus Ultimately, the mother’s informed decision is decisive***** |
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Care of pregnant women with other medical problems
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Sometimes suboptimal treatment may jeopardize the fetus or the fetus may be harmed by the drugs
The pregnant woman must decide what risks to the fetus are acceptable in view of the interventions overall benefit It is inappropriate to withhold interventions or to insist that women obtain an abortion as a condition of treating her medical conditions |
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Substance and alcohol abuse during pregnancy
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Many states permit involuntary commitment of pregnant women who use certain illegal drugs
In a few states drug abuse during pregnancy triggers child abuse laws New pushes for substance abuse treatment during pregnancy over punishment |
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Objectives again
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Explain the ethical and legal framework for decision making concerns in infants and children
Describe the concept of a mature minor and differentiate it from the concept of an emancipated minor****EXAM Describe the unique dilemmas associated with OB/Gyn and reproductive medicine Identify issues in maternal/fetal conflicts Apply the case analysis process to cases in pediatric and reproductive ethics |
