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Harrison et al.

Harrison et al.

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Harrison et al.

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  1. Harrison et al. Bioethics for Children: Involving Children in Medical Decisions

  2. Samantha’s 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 child’s 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 child’s best interets. They can’t be as idiosyncratic in their decisions – e.g., JH’s 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 child’s family.

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