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Ethical Decision Making:

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Children and Neonates. Medical Decisions: Children. Parents are surrogate decision makers. Most parents seek the welfare of their children ... – PowerPoint PPT presentation

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Title: Ethical Decision Making:


1
Ethical Decision Making
  • Children and Neonates

2
Medical Decisions Children
  • Parents are surrogate decision makers
  • Most parents seek the welfare of their children
  • Parents should be assisted supported in their
    role as decision makers
  • Parents must be mentally competent
  • Require necessary information to make an informed
    decision

3
Best interests of child
  • ethical and legal standard according to which the
    immature child is to be protected from physical,
    mental, emotional abuse and neglect

4
Determining Best Interests
  • Consider
  • Is treatment likely to improve childs condition?
  • Will condition deteriorate without treatment?
  • Weigh anticipated benefits and harms
  • Is proposed Tx the least possibly intrusive and
    restrictive?

5
Best Interests Test Parents and Guardians
  • Physician cannot treat a child without consent of
    the parent(s)- exception mature minors,
    emergency doctrine
  • Parents obliged to provide necessities of life
    for their children
  • Parental duty to provide care that is reasonable
    and appropriate

6
Child in Need of Protection Child and Family
Services Act, 1989
  • Child in the care, custody, control of one who
  • neglects or refuses to provide or obtain medical
    care/treatment necessary for health or well-being
    of the child
  • or who refuses to permit such care when
    recommended by qualified medical practitioner

7
Circumstances sufficient to suspend duty to
prolong life (Canadian Pediatric Society)
  • Irreversible progression of condition to imminent
    death
  • Tx clearly likely to be ineffective or harmful
  • Life will be severely shortened regardless of
    treatment and non-Tx will allow for more comfort
    caring
  • Intractable and intolerable pain suffering

8
Futility
  • Medical treatment seen to be non-beneficial
    because it is believed to offer no reasonable
    hope of recovery or improvement in pts condition

9
Futility
  • Quantitative (objective) determined by
    physician
  • Qualitative (subjective) determined by patient
    and family

10
Futility- Categories
  • Not futile benefits to both physical and overall
    well-being
  • Futile Non-beneficial to either physical or
    overall well-being
  • Futile from pts perspective medically indicated
    but not valued by pt
  • Futile from clinicians perspective valued by pt
    but not medically indicated

11
Futility
  • Canadian medical law currently recognizes
    negative right not to have treatment
  • Does not recognize positive right to demand
    treatment caregivers view as futile eg.
    Sawatsky

12
Is refusal of CPR justified paternalism?
  • Some argue that to offer CPR in futile
    circumstances diminishes autonomy
  • Offers choice which is not actually viable
  • No DNR does not mean no care
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