In Defense of Best Interests: When Parents and Clinicians Disagree

Coulson-Smith, Peta; Fenwick, Angela; Lucassen, Anneke

doi:10.1080/15265161.2018.1485766

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Best interest considerations do not have to be exclusive to the child with medical needs and can encompass wider contextual factors. 7 In practice, decisions in the best interests of the child are usually made with consideration to the interests of the wider family, without reaching a threshold where interests compete or offer significant harm.…”

Section: Best Interestsmentioning

confidence: 99%

As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence

Turnham,

Bowen,

Ramdas

et al. 2023

J Med Ethics

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Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited, can considered to be a harm in of itself. Discharge home offers the possibility for an improved quality of life for the child and their family but comes with significant medical risks.When making decisions for children, two ethical models predominate, the promotion of the child’s best interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting and/or life-threatening illness, all options may be associated with risk. There are no good options, only potentially harmful choices.In this paper, we explore decisions made by one family in such circumstances. We describe a model adopted from risk management programmes beyond medicine, which offers a potential framework for identifying risks to the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be acceptable when undertaken in the pursuit of a specified desired good, so long as they are as low as reasonably practicable.

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Section: Best Interestsmentioning

confidence: 99%

As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence

Turnham,

Bowen,

Ramdas

et al. 2023

J Med Ethics

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“…It is dubious whether the state or clinicians can as effectively 'focus on the child by considering the broadest view of best interests, accounting for that child's unique clinical, familial, and cultural circumstances' 20 as competently as attentive parents can. 2f Moreover, with a history of harmful interventions for the supposed benefit of children, 21 the state's judgement should not be assumed to be benign or necessarily be embraced as superior to prima facie caring parents -the state certainly cannot love a child.…”

Section: Solutionmentioning

confidence: 99%

Should parents be asked to consent for life-saving paediatric interventions?

Gamble

Pruski

2020

Journal of the Intensive Care Society

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Informed consent, when given by proxy, has limitations: chiefly, it must be made in the interest of the patient. Here we critique the standard approach to parental consent, as present in Canada and the UK. Parents are often asked for consent, but are not given the authority to refuse medically beneficial treatment in many situations. This prompts the question of whether it is possible for someone to consent if they cannot refuse. We present two alternative and philosophically more consistent frameworks for paediatric proxy consent. The first allows meaningful consent (parents may say ‘yes’ or ‘no’ to treatment), provided that parents are medically informed/competent and intend the health and well-being of their child. In the second solution, medical practitioners or the state consent for treatment, with parents only being consulted to help give insight to the child’s circumstances. While we contend that either of these two options is superior to the insincerity of the present paradigm, we suggest that the first solution is preferable.

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“…Overriding parents' decisions is particularly fraught with conflict as new treatments and technologies are introduced for diagnoses that are inherently uncertain and complex. [11][12][13][14] Pediatric ethical principles and guiding frameworks, though sometimes conflicting, can be applied to various clinical scenarios with young patients of various ages. 15,16 These include various formulations of the best interest standard, avoiding harm, constrained parental autonomy, shared family-centered decision making, clinically reasonable alternatives, responsible thinking, and rational decision making.…”

Section: Guidelines For Shared Decision Making About New Technology Usementioning

confidence: 99%

Should Physicians Offer a Ventricular Assist Device to a Pediatric Oncology Patient With a Poor Prognosis?

Patel

Joong

Lelkes

et al. 2019

AMA Journal of Ethics

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In Defense of Best Interests: When Parents and Clinicians Disagree

Cited by 5 publications

References 5 publications

As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence

As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence

Should parents be asked to consent for life-saving paediatric interventions?

Should Physicians Offer a Ventricular Assist Device to a Pediatric Oncology Patient With a Poor Prognosis?

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