Disclosing Illness in Children - Essay Example

? Disclosing Illness in Children Introduction The problem of diagnosis disclosure is considered in the paper. Ethical implications of diagnosis disclosure to children are considered in detail. Appropriate studies and researches are required in this field in order to evaluate the relevance of diagnosis disclosing in any special case. It is better to prevent children from false informing and provide them with relevant information about disease and illnesses in order to reduce social pressure or social restriction. Identification of a dilemma It is necessary to keep our children living in the fair world. No challenges and obstacles should be oppressing our children. These claims are often provided by loving and caring parents. Very often they hide the truth from their children. In the context of medicine, ethical concerns are one of the most important. Therefore, when parents want to keep their children from knowing truth about their diagnoses, they are following such tendencies as fear to reduce child’s desire to live; avoid depression in their child, avoid social oppression or rejection etc (Hendrick, 2004). On the other hand, they are only complicating the situations, because children may be informed by third parties and then the pressure on them will be even more intense. There is a need to inform a child about the illness within family and develop illness coping strategies for sure (Leathard, McLaren, 2007). `In case children know their diagnosis, it will be easier for them to have higher self-esteem and to cause lower depression levels among their parents. In the case scenario, a child does not know about her diagnosis hepatitis B. Her liver is being gradually destroyed and her mother wants to keep her uninformed about her status. On the other hand, it is better to inform the girl, because in such a way the danger of illness is potentially hazardous for her sexual partners for sure (Butts, 2008). Social implications of hiding the true diagnosis from a child may result in ruined friendship or damaged social contacts, distancing of family members and many other unpleasant things. It is better to inform the child about her diagnosis by family members at once. Of course, it is relevant to take into account child’s age and to find the best convenient time and ways of a child’s informing. There is a need to widen horizon of the neighbors or relatives about the illness in order not to keep them in fear. For example, the way HBV is transmitted is often unknown for people. All physicians of a child and family, few friends and family members should be informed about a child’s diagnosis for sure (Dowrick and Frith, 1999). Of course, there is a chance that these people would remain aside this problem or would not understand your family, but it is better not to hide the truth for sure, but fight for a tolerant attitude to a child. There is a need for support from family members or friends. At this stage it is desirable to provide these people with relevant information about the disease (Reamer, 2005). Proper and on-time informing is worth consideration at different stages of diagnosis disclosure. Not only children should be prepared for this process, but all family member and the closest friends in order to support them. When child is at high school, she will be able to decide whether inform or not inform her friends about her diagnosis (Waz, 2010). Discussion and integration of the ethical principles and theories Treatment providers, the members of the family with HBV should follow ethics code. The highest standards of care should be developed in terms of ethics code. There is no need to choose between right or wrong decisions. There is a need to balance ethical concerns of family members, teachers and medical staff in every particular case. Thus, it should be noted that professionals in medical sphere would always act in the interests of their client. For example, in this scenario they are worried about potential health hazards to her surrounding people and friends. Her mother is keeping secrets from her about her illness only driven by the necessity to hide the truth from the neighborhood. Her fears are exaggerated and maybe even invented, but doctors are afraid of real health hazards. Therefore, it is necessary to develop principles of clarifications of diagnosis to the patients, especially to children. Such documents as Rules of Professional Conduct, various documents and regulations have been developed by the American Associations of Doctors in order to address various ethical issues. Ethical decision making in medicine is a challenging and at the same time very interesting sphere. It is focused on different concerns of patients and doctors (Berglund, 2007). It is not easy for doctors to remain cold-blooded and inform the patients about their illnesses at once.   The most challenging aspect of ethical decision-making in medicine concerns children. Very often their minds have been referred in medicine as to immature nature of children, their inability to realize the depth and seriousness of their diagnoses etc (Biggs, 2006). Parents own their children, and they are their property- this approach has been often propagated in different aspects of human activities, social life, law etc. Many of us often forget that children also have their rights. Of course, as we have already noted, it is desirable to select a perfect age for informing children about their illnesses or diagnosis. Thus, in accordance with the common law: “children up to the age of seven were considered doli incapax (i.e., the defense of infancy)” (Koocher and Keith-Spiegel 1990, p. 3). It means that their minds are not able to perceive too complicated information and it is necessary to develop certain approaches and strategies in informing children about the most challenging issues, especially their diagnosis. Evidence of a structured approach to ethical decision making There is a need to develop relevant ethical framework for medical staff in terms of present theories and suggested approaches in bioethics. For example, in the current case, the common good approach and the virtue approach were chosen as the most appropriate within the context. It can be proven, because all children live in the community and it is relevant to take into account the interests not only of a child, but also of the whole community. In accordance with the Greek philosophers, it is necessary to direct our actions on a common good of the society. There is a need to reach common good by taking into account the interests of every person (Petronio, 2000). In terms of the virtue approach it should be noted that the virtue of everyone should be taken into account. Thus, for example, it is relevant to understand that Sarah is still a child and it is difficult of her to cope with psychological pressure in case she knows her diagnosis. On the other hand, this girl can meet someone and then his welfare will be endangered. Doctors in terms of this approach should ask them, if it is fair to tell the truth to the patient and what kind of person s will they be in case they do not inform her (Tingle, Cribb, 2007). Therefore, medical staff should work hard in order to make the best decision and to decide whether to tell or not to tell the truth to the patient. Structured ethical decision-making There is a need to take the number of steps in order to make the right decision. First, it should be solved whether revelation of a true diagnosis will not be intimidating for health of a patient. The second step is to collect relevant facts about the patient and decide if something important is left beyond attention in this situation. For example, if Sarah meets a boyfriend, there is a need to inform her about illness as soon as possible in order to prevent health hazards, which may be caused to another person. Which concerns are more important and why and how to act? For medical staff it is also important to take creative steps in their decisions. Therefore, it is necessary to make a decision, which solution would be less harmful and produce more good? The following ethical grid of Seedhouse is a perfect option to make a right decision Seedhouse ethical grid Integration of a variety of theoretical considerations There is a need to integrate theoretical developments in the field of decision making and illness revelation for children in order to identify the best solution for this scenario. Starting from 7os a great attention is paid to developments and treatment of children’s illnesses. Moreover, ethical implications of diagnosis revelation were also taken into account by medics. In the beginning of researches and studies in this field, it was suggested that emotional burden of children’s illness awareness is too hard for them (Schwartz, 2011). The following steps in this field were taken: children were more open to illness-related communication; survival rates of children’s recovery improved; children were less oriented to negative outcomes of their illnesses and death. In accordance with Schwartz (2011) children were open to protective communication of their parents. Thus, they experienced more difficulties than in case when they were not shown the truth.  In 90s this paradigm was focused on finding the best answers and strategies: how the child should be told about his diagnosis and not when he should be told. There is a need to take into account emotional and cognitive abilities of children prior to diagnosis disclosure. The meaning of illness and death is strange for children and it is necessary to focus on two of these concepts separately. Sometimes the process of diagnosis disclosure is correlated with Piagetian stages of cognitive development (pre-operational level, concrete level and formal operational levels). Therefore, it is necessary to provide children with relevant information even about the issues, which are not quite understandable for children (Radest, 2000). Lack of considerations Very often disclosed information is suggested to be told to children. Unfortunately, there are no developed principles of diagnosis disclosure. There is a need to focus more on modern developments in the field of ethics, when it concerns modern medicine (Murray, 2006). Such issues as patterns of disclosure; factors influencing the process of disclosure and non-disclosure; psychological negative outcomes in the process of disclosure and intervention studies should be taken into account by children. As far as we can see, there are numerous gaps in this field of study. Ethical implications of diagnosis disclosure integrate social, psychological, cognitive and many other aspects. Conclusion Ethical implications of diagnosis disclosure to children may concern such aspects, as the rights of children and their parents; values and principles of behavior; attempts to treat everyone equally and follow moral norms and practices of behavior; dependence on relations between children and parents; values and good approach or implementation of any other approach. References 1. Berglund, C., 2007. Ethics for Health Care. Oxford University Press. 2. Biggs, H., 2006. Healthcare research ethics and law: regulation, review and responsibility. London, UCL. 3. Butts, J., 2008. Nursing ethics: across the curriculum and into practice. London: Jones and Bartlett Publishers. 4. Dowrick, C. and Frith, L., 1999. General Practice and Ethics: Uncertainty and Responsibility. Routledge. 5. Hendrick, J., 2004. Foundations in Nursing and Health Care - Law and Ethics. Foundations in Nursing & Health Care: Stanley Thomas. 6. Koocher, G.P. and Keith-Spiegel, P.C., 1990. Children, Ethics and the Law: Professional Issues and Cases. Lincoln, Nebraska: University of Nebraska Press. 7. Leathard, A., McLaren, S., 2007. Ethics: contemporary challenges in health and social care. Bristol: Policy. 8. Murray, Dinah, ed. 2006. Coming out Asperger: Diagnosis, Disclosure, and Self-Confidence. London: Jessica Kingsley. 9. Petronio, Sandra, ed. 2000. Balancing the Secrets of Private Disclosures. Mahwah, NJ: Lawrence Erlbaum Associates. 10. Radest, H. B., 2000. From Clinic to Classroom: Medical Ethics and Moral Education. Praeger Publishers. 11. Reamer, Frederic G. 2005. "Update on Confidentiality Issues in Practice with Children: Ethics Risk Management." Children & Schools, April, pp. 117+. 12. Schwartz, Peter H. 2011. "Decision Aids, Prevention and the Ethics of Disclosure." The Hastings Center Report 41:30+. 13. Seedhouse, D., 2007. Ethics:The Heart Of Health Care (3rd Ed): Wiley. 14. Tingle, J., Cribb, 2007. A Nursing law and ethics. Oxford Blackwell. 15. Waz, Wayne R. 2010. "The Need to Know: Disclosure of Information to Pediatric Patients." Ethics & Medicine 26:75+. Read More