1. Children and Young People Flashcards
What 4 factors need to be considered when undertaking a medical elective in resource poor countries?
- Stay within your competence
- Maintain ethical standards
- Develop “cultural competence” (Bowman, 2011)
- Minimise burden on host country & healthcare system
Who is classed as a child and young person?
Under 18 in England, Wales and NI
Under 16 in Scotland
Children = People who aren’t mature enough to make important decisions for themselves
When a child lacks capacity, who makes the decision?
Parents
BUT decisions are constrained by best interests of the child. If not then wishes can be overridden.
Note: If assent can be given, it should be sought
As well as clinical best interest, what else should be considered?
a. the views of the child or young person
b. the views of parents
c. the views of others close to the child or young person
d. the cultural, religious or other beliefs and values of the child or parents
e. the views of other healthcare professionals involved in providing care
to the child or young person
f. which choice, if there is more than one, will least restrict the child or young person’s future options.
Name 2 cases in which there was conflict due to doctors and parents disagreeing?
Case 1: Re S (Parents - Jehovah’s Witnesses)
S was 4 1⁄2 years old with T cell leukemia
Undergoing chemotherapy & blood transfusion would improve recovery
Parents refused (religious & safety reasons) Refusal overruled
Case 2: Re A (Jodie & Mary, conjoined twins)
- If they remained together, they would both die
- If separated, Jodie would live, Mary would die
- Doctors wanted to act to separate, parents did not allow
- High court, then court of appeal
- Separation took place
What does “Gillick Competent” mean?
A young person under 16 with capacity to make any relevant decision
How is competence determined?
Understand, retain, use/weight this information and communicate decision
Explain, using either the lock/key or flak jacket analogy, why treatment can go ahead, even if a young person does not give their consent?
Consent is often more easily accepted than refusal. Why?
– Key & lock analogy (then, flak jacket)
– Doctor needs only 1 key to unlock “consent”
– 3 keys potentially exist in the case of the mature minor:
• Mature minor
• Parents (right co-exists)
• Courts
Outline the Hannah Jones as a mature minor case?
Upheld refusal of heart transplant after long term illness
13yrs old
PCT sought court order for heart transplant for 13 yr old girl (she had refused to undergo the transplant – her parents agreed with her decision)
Child protection officer said Hannah was adamant.
Refusal respected
(Note: agreed to transplant the following year, and is currently doing well)
What are the laws on living children organ donors?
Scotland: Under 16’s cannot be living donors
England, Wales and NI: Solid organ donation by living children is permitted
BMA were opposed, now support so long as young person is competent to give valid consent and is not under coercion
What are the euthanasia laws for children in Europe?
In the Netherlands, euthanasia is legal for those over the age of 12 (with permission of their parents) - the Dutch Paediatric Association has now called for age limit to be lifted altogether (June 2015)
Belgium lifted all age restrictions in 2014
What are the ethical issues surrounded children and clinical research?
For:
-Research with children is crucial if children themselves are to benefit from the best possible treatment when they are ill.
Against:
- Whether parents should or ought to allow their young children to participate in research that involves even minor discomfort or distress to,
- The question of whether parents or children should have a right to participate in research – a right, for example, that may be claimed where a child is very seriously ill and a new, as yet-unlicensed, treatment is seen as being their ‘only hope
What is the eu regulation regarding generics and bioavailability?
Generics must have a bioavailability of 80-125% compared to the reference product (EU reg.)
