The Pediatrician's Dilemma: Respecting Parental Autonomy Versus Protecting Vulnerable Children

Best Interest Standard in School Health: A Concept Analysis

“…(Bester, 2018b, p. 17) The BIS is not simply maximizing benefits and minimizing harms, it is also flexible and intended to be a regulative ideal, not strict nor taken literally (Diekema, 2019;Ross, 2019a;Ross & Swota, 2017). Family dynamics, psychosocial, health, relational, cultural, developmental, temporal, financial, and other externalities or practical constraint factors are all considered influential contextual aspects of the BIS to promote and protect the child's well-being (Affdal & Ravitsky, 2018;Bronfenbrenner, 1979;Gomez et al, 2016;Stewart & De Marco, 2018). The BIS definition does not stop with the immediate needs of a child but is also applicable to the future interests of a child (Affdal & Ravitsky, 2018;Bester, 2019aBester, , 2018bHubbard & Greenblum, 2019;Salter, 2012).…”

“…The BIS's application across these diverse disciplines and subgroups contribute to its place as the prevailing ethical paradigm for pediatric decision-making. The BIS has been used to facilitate health care decisions regarding growth hormone treatments, gender assignment surgeries, life support withdrawal, vaccination choice, child organ or tissue donation, nonbeneficial research participation, and elective surgeries for schoolaged children (De Vries, 2013;Gomez et al, 2016;Klein & Saroyan, 2011;Noggle, 2013;Sullivan et al, 2015). The BIS has also facilitated decisions that involve family discord and the active or passive choice of a parent/guardian to not make a decision (Brown, 2018;Piasecki et al, 2015;Sachdeva & Morris, 2013;Taylor, 2018).…”