Flashcards in Treatment decisions regarding infants, children and adolescents Deck (21):
What are some principles regarding treatment decisions in pediatrics?
1. All infants, children and adolescents – regardless of physical or mental disability – have dignity, intrinsic value, and a claim to respect, protection, and medical treatment that serves their best interests.
2. Although family issues are important and must be considered, the primary concern of health professionals who care for children and adolescents must be the best interests of individual children and adolescents.
3. Decision-making for children and adolescents should be interdisciplinary and collaborative, and should actively involve the family and, when appropriate, the child or adolescent.
4. Children and adolescents should be appropriately involved in decisions affecting them. Once they have sufficient decision-making capacity, they should become the principal decision maker for themselves.
5. All information presented to patients, families, or the child or adolescent’s legal guardian should be truthful, clear and presented with sensitivity. This information should include evidence available in the literature, and the clinical experience of the physician and his or her colleagues.
6. A physician’s personal and professional values can influence patients and families. The reflective practitioner is aware that personal values should not be allowed to restrict or bias such things as options offered to patients or families.
7. The principal obligation of the physician is to the individual patient rather than to society or the health care system. Physicians should act as advocates for their individual patients when scarce resources seem to limit access to care.
What are the three hallmarks if informed choice?
1. Appropriate information to make a decision
2. Decision making capacity
What is a substitute decision maker?
Know the patient so well as to have already discussed with the patient what he or she would want done; a substitute’s role is to promote the patient’s expressed wishes
What is a surrogate decision maker?
Do not know what the patient would want done and are thus charged to decide in the best interests of the patient
When might a parent not be an appropriate surrogate decision maker?
1. when parents lack decision-making capacity.
2. when there are irresolvable differences between parents regarding the child or adolescent’s care.
3. when parents have clearly relinquished responsibility for the child or adolescent.
4. when a legal guardian has been appointed.
What factors should consideration be given to in determining the best interests of a child or adolescent?
1. chances of survival;
2. the harms and the benefits of treatment;
3. evidence regarding long- and short-term medical outcomes of the treatment;
4. long-term implications for the child or adolescent’s suffering and quality of life.
What is the standard of reasonableness?
This standard asserts that the best option is one that most rational people of goodwill would choose after full consideration of all factors that influence the situation
What is the recommendation in an acute situation when treatment cannot be deferred or delayed and circumstances have not been clarified?
Presume in favour of life-saving or life-sustaining treatment
What is the recommendations regarding disclosure of medical information to the child?
They should receive developmentally appropriate information and their desire or need for information is paramount over parent's views regarding disclosure
What should be used to allow children to participate in making decisions?
What is the ability of infants and young children to participate in decision making?
What is the ability of primary school age children to participate in decision making?
May participate but do not have full decision making capacity. They can provide asset but cannot provide consent.
Strong or sustained dissent should be taken seriously
What is thee ability of adolescents to participate in decision making?
Developing the decision-making capacity of adults
What is an emancipated minor?
No longer dependent on their parents and are supporting themselves or living independently from their families
What is a mature minor?
Persons who, regardless of their age, are able to understand their health condition, and appreciate the nature and consequences of proposed treatment options
What are Canadian laws of consent?
Variable, but the mature minor principle is applicable everywhere
When is withholding or withdrawal of treatment considered?
1. there is irreversible progression to imminent death;
2. treatment is clearly ineffective or harmful;
3. life will be severely shortened regardless of treatment, and the limitation or withdrawal of interventions will allow greater palliative and comfort care;
4. lives will be filled with intolerable distress and suffering that cannot be prevented or alleviated.
Who should be involved in decisions regarding withdrawal of care?
Members of the interdisciplinary team
What should be done if the parents refuse to limit treatment that the health care team believes is not beneficial?
In this situation, if the health care team, an ethics committee or consultant (if available), and an uninvolved medical consultant all agree that treatment is contrary to the best interests of the child or adolescent, a legal opinion may be sought with consideration toward a legal appeal to apprehend medical decision-making for the child or adolescent
What to do when physician and health care team feel the parent's decisions are inconsistent with the child's best interest?
Involve an ethics consultant and consider involvement of child protection and legal system