Harrison et al.

1
Harrison et al.

• Bioethics for Children Involving Children in
  Medical Decisions

2
Samanthas case

• 11 years old with osteosarcoma in left arm
• Arm amputated chemotherapy given
• Cancer free for 18 months before returning
  metastasizing in her lungs.
• 20 chance of successful recovery
• Samantha distrusts the health care workers and is
  angry at them and her parents.
• Samantha refuses further treatment

3
Ethics and including children

• Moving away from traditional model where
  physicians and parents made all medical decisions
  of behalf of children to one where children are
  increased involved somehow in the decision.
• Best to use a family centred approach, which
  considers consequences to all family members.
• Difficult here because disagreement in the family
  the parents want to continue treatment.

4
Ethics and including children

• Triadic relationship that involves physicians,
  parents and child.
• The childs input will depend on their level of
  cognitive and emotional development. The child
  must be worked with, by a variety of health care
  workers, to ensure s/he is made as capable as
  possible in dealing with the situation.

5
Law, children and proxy consent

• A patient's right to refuse even life saving
  treatment is recognized in Canadian law.
• mature minor recognizes that some children are
  competent to make medical decisions.
• When child not competent, the parents typically
  are the proxies but they must make decisions in
  the childs best interets. They cant be as
  idiosyncratic in their decisions e.g., JHs and
  blood transfusions.
• Restraints

6
Policy, etc.

• In CAN, no policy on the role of children. In US,
  policy is as above. Proxy but in best interests
  of child.
• Developmental psychology infants young
  children vs. primary school children vs.
  adolescents.
• Considerations potential benefits to child
  potential harmful consequences (including
  psychological etc) moral, spiritual and cultural
  values of the childs family.

7
Case

• Samantha included in decisions, which involves a
  large team.
• Decide upon palliative care.