Medical Decision Making for Minors - Research Paper Example

Medical Decision Making For Minors End of life decisions, Parents should not be the sole in charge of life altering medical decisions making for their children. In the past, minors were not considered legally and reasonably competent enough to make intricate decisions regarding their health. This inability was associated with their age. The issue has become controversial ever since children’s decision making is being overruled by the authorities. Much debate has been produced by law makers and medical professionals in favor or against the choice of continuation or discontinuation of treatment to the afflicted individual himself, disregarding the fact that the patient is a minor or an adult. The focus of the issue is that, to what extent parents are responsible for making appropriate medical decisions for their children and what are children’s right in this context. In general parents are conscientious for care and guardianship of their children and that is why they are presumed to have the ability to make the best decision for their child’s betterment. However, in the case of adolescents, the situation is quite confusing as they are psychologically mature enough to make a decision for themselves but are irresponsible and often overlook the long term consequences and impacts of those decisions on their lives which might be due to their impulsive nature. Decision of minors should only be considered after assuring that the adolescent is aware of the purpose of treatment, risks, benefits, side effects and alternatives of the treatment with a guarantee that the minor is able to make an informed decision. (Hickey, 2009) Since 1976’s publication of American Academy of Pediatrics (APP) the legal concept of informed consent has become developed and more formal than the past. (Bartholome,1995). Now the law suggests that physicians should involve children and parents both in seeking the appropriate medical treatment for minors. This also allows physicians to contradict or challenge parent’s decision if their decision puts the child’s life at stake. Still states and courts don’t allow the children’s, less than twelve years of age, to make medical decisions for themselves. Responsibility of making medical decision falls on the shoulders of parents. Even though in the cases of harm subjected to the child by their parents, law has limited authority and ability to challenge their position.(Jennifer& Rosata,2009). Law favors the rights of parents on the basis of chronological age, self sufficiency and marital or parental status. Since it is a controversial issue, there is wide difference in states decisions in response to these disputes.(Hickey,2007) Technology’s advancements sometimes cross the ethical, legal and religious boundaries set by a society. More problems are being created by medical modernization in which law is still unprepared to embark upon. Sophistication in medical treatments is directly proportional to complexity in appropriate decision making for minors. Sometimes, children’s disabilities create problems for the parents. Such children are not only financial burden on the family but also a reason for emotional strain. Disabilities of children consume time, attention, energy and money and other children’s requirements go unmet. Therefore, sometime parents decide to abort a baby who is expected to have a disability or they choose genetic traits for their babies through various innovative technologies. Technologies such as invitro fertilizations, egg freezing and assisted reproductive technology (ART) requires serious legal considerations because they can create further problems for the children in their future such as custody and support disputes that occur between possible parents in ART. Due to these innovations, law against the issues such as selection of appropriate treatment for minor by their parents by themselves, is also very unstable and vague. Even in cases of end of life care decisions, parents are the ones to decide to prevent the child from unnecessary sufferings. The concept of autonomy is criticized for failing to regard a person as a part of complex network of relationships. In end of life decisions not only a person’s view but everyone close to the sufferer should be considered because as life sustaining medical decisions influence family and friends, life ending decisions also produce consequences on others. Some bioethicist claims that these considerations should be taken into account while dealing with such life altering decisions but most of them reject it stating that a right to live and the way to stay alive solely depends on the one leading it, either adult or a minor.(Meisel,2005) Law has limited power over the right of parents to make decisions for their children and parent’s decisions are guided by ethics of their physicians. Initial concept of “Physician knows the best” is being abundant by the families and now decision power is being shared between physician, patient and patent’s family. However, it is a shared responsibility also when it comes to the decision making for minors as parents often breach their obligation of providing care to their children. Their decisions should be reviewed and overruled, when appropriate. There are a number of reasons why minors should also be informed and involved in a medical decision about their health. First it is the ethical principle of patient’s self determination and independence and informed consent and applies equally to both adults and minors. It allows him to overview his condition and what should he be expecting from the treatment or tests. It presents an example of open communication between physician, patient and their families and this also shows respect for child’s capacities and will help in their further development. Parent’s decision regarding minor’s medical conditions can be overruled or at least reviewed depending upon the capacities of children to make an appropriate decision for them and this capacity can be explored by understanding child’s development. Informed consent involves understanding of the conditions, risks or benefits etc; it is the ability to understand information considering the risk benefit ratio of proposed treatment. If the treatment is simple and risk free and the patient refuses it than he is considered incompetent. The decision taken should be voluntary and without any intimidation. And assessment of the person’s understanding of the information is also necessary. Competence is determined by the appropriate decision made by the person after a reasonable decision making process with other choices keeping in mind. Parent’s competence is rarely challenged except in the cases of refusal of treatment continuation, treatment they select is not in favor of minors’ health, treatment involves rights to privacy of minors such as reproductive care or psychotherapy or when conflict of interest arises. (McCabe,1996).There are conditions where law allows a mature minor to receive medical treatment without the approval of their parents, the age of autonomous decision making varies in different states. Such as in 1976, US Supreme Court approved that a minor can get an abortion, treatment of sexually transmitted diseases, substance abuse without the parent’s consent. Court realized that patients will seek treatment for sensitive issues when parents are not involved. On the basis of services and status they were allowed independent medical treatments. Status involved, a married minor, pregnant minor, minor with children, financially self sufficient minor, a victim of sexual abuse minor. In such matters minors are allowed to consent for themselves. Except in few states where teenager’s parents decide what is best for them. The reason is the lack of proper knowledge about adolescent decision making capability and absence of appropriate policy which results in distracted decisions making of minors. Law approves serious punishments for the minors who try to commit suicide but it does not allow terminally ill minors to decline aggressive and non-therapeutic medical procedures. A patient’s reluctance to agree or disagree with a treatment which is not essential for his her welfare and can be deferred without any risks should be considered while making decisions. Medical professionals should be sensitive enough to withhold the treatment until a minor comes to terms with his fears or concerns about his treatment. However, inconsistencies in legal policy regarding these issues produce difficulties in appropriate decision making which maximizes patient’s ethics and patient autonomy. Child’s consent is especially important when the clearness of the right decision is not evident. However, there is also a risk of placing high responsibility of decision making on the shoulders of minor when he is not completely capable of interpreting provided information because understanding can only be inferred and not observed and this can also release parents from their primary duty of provision of care.(Shaw M.,2011) However, there is also no evidence, robust enough, to support idea of presumed incapacity of the minor’s decision making. It is basically based on the observation of minors vulnerable and careless nature that they are deprived of thinking what is best for them.(Gay& Hartmen,2002). Capacity of decision making and self determination don’t appear magically on a person’s 18th birthday, therefore, more research is required in the fields of determining decision power of ill children about their health. The philosophy that government should be responsible in protecting the rights of the minors(Parens petriae) needs to be shaped, that recognizes minor’s legal autonomy of decision making. Early social and cultural norms declined the right of minor’s which tended to diminish the moral status of children and adolescents but today’s parens petriae should be responsive to the legal rights of minor’s decision making especially in the cases of life altering and critical decisions. Thus for the care of children abusing raw power over children when ethical conflict arises, should be avoided. Ethical conflicts should be resolved by additional consultations, counseling, multidisciplinary discussions. Because there is no specific distinguishing factor that notifies that a minor is now able to make an appropriate decision for his wellbeing, so now courts have recognized an exception to the common law which is called mature minor doctrine and allows minors who are capable of understanding short and long term consequences of their decisions, to make selection regarding their treatment. The circumstances which allow a minor to pick a treatment are: A minor who is older than 14 years.(older adolescent) A minor capable of informed consent Treatment will benefit the minor and does not pose any potential risks to health. Treatment is within established medical protocols. Not every state approves of Mature Minor Doctrine but various courts are scrutinizing the ability of mature minor’s decision making. For example, if a terminally ill minor is mature enough to recognize that no good will come to him even after a very costly treatment approved by his guardians then he/she is allowed to refuse the continuation of the treatment. Ethically it is permissible to deny the resources if they are of little or no benefit. However, opponents suggest that denial of treatment should be made at the level of policy rather than individual decision. Another dilemma arises when physician and parents think that a treatment is worthless and it will only increase the suffering of the patient and family but the patient wants it anyway, a lot less attention has been paid attention to this scenario.(Maisel, 2005) A numerous different medical conditions are present where law approves consents from parents or patients or both to be involved before making a decision. Such as cases involving young children and infants depend solely on parental decisions. Older school age children’s medical care involves the consent of both parents and patient. In most instances adolescents’ and young adults approval of treatment is sought when making a progress with a procedure such as examination of body in a 16 year old, fertility control in a 17 year old, surgical interventions of tumors in adolescents. Judgments about competence can only be made while taking into account the type of decision and circumstances including the quality of information provided to the minors. Supportive parent child relationship and doctor patient relationship leads to a competent decision making. AAP suggests that a number of conditions still, to date, require parents consent to undertake recommended medical treatments. However, in the cases of mature minors decisions can directly be taken by the minor himself. End of life decisions require much attention of the authorities, care givers and parents. Opinion of minor, parents and physician should be considered in such cases. Decision of end of life by parents, when considering the risk- benefit ratio of the treatment or consumption of the scarce resources is the least discussed topic which needs more attention of the governing and policy makers. Top of Form Basic Outline INTRODUCTION History of development of the Minors right of decision making issue Role of science in complicating the decisions BODY Law and Ethics Consent of Minors Limitations of Minor’s Consent Parent’s consent and its limitations Current Policy Minor’s Competence Mature Minor Doctrine Medical conditions and Physicians ethical duty CONCLUSION BIBLIOGRAPHY: Bartholome, WG. "Informed Consent, Parental Permission, and Assent in Pediatric Practice." Pediatrics. 96.5 (1995): 981-2. Print. Bottom of Form Jennifer L. &Rosata D.,FOREWORD,2009http://www.law.uh.edu/hjhlp/Issues/Vol_82/Rosato.pdf Hickey, K. "Minors' Rights in Medical Decision Making."Jona's Healthcare Law, Ethics and Regulation. 9.3 (2007). Print. McCabe, MA. "Involving Children and Adolescents in Medical Decision Making: Developmental and Clinical Considerations." Journal of Pediatric Psychology. 21.4 (1996): 505-16. Print. Meisel, Alan. "The Role of Litigation in End of Life Care: a Reappraisal." Hastings Center Report. 35.6 (2005). Print. Mike Shaw, Advances: Competence and consent to treatment in children and adolescents,2011http://apt.rcpsych.org/content/7/2/150.full Read More