Ethcal Dailama Year Three

Ethical Dilemmas
in
Minors
Content of presentation
• Introduction
• Who should make health-care decisions for children?
• Decision making and the concept of ‘best interests’
• Children and consent
• Other important ethical issues in treating children
• Refusal of medical care
What is “Ethics”?
“Ethics is a branch of
philosophy; the formal,
rational, systemic examination
of the rightness and wrongness
of human actions.”
Introduction
What is an ethical dilemma?
• An ethical dilemma is any situation in which
guiding moral principles cannot determine
which course of action is right or wrong
• Ethical dilemmas occur when patients and

families disagree on the treatment plan
• Treating children is different from treating
adults
• The main difference lies in the fact that
children are not autonomous
Principles of ethics:-
• Autonomy- Respect for the right of self-
determination choices and to take action based on
their values and beliefs
• Beneficence -The obligation of members of the
profession to help others
• Confidentiality- preventing disclosure of
information received in the context of a professional
relationship
• Fidelity - keeping one's promises
• Justice- offering fair and equal treatment to all
• Non maleficence - the obligation to "do no
harm”
• Privacy - respecting people's personal decisions
about when and what information to provide
about themselves
• Veracity – truthfulness
• Respect for Societal Institutions
Life, culture, family, religion
Principles of Ethical Decision Making
WHO SHOULD MAKE HEALTH-CARE DECISIONS FOR CHILDREN?
• Children are not autonomous and therefore

their parents are required to make health-care
decisions for them
• This is based on the assumption that they
love their children, and share common goals
and values
• Parents have an obligation to care for their
children and should have their children’s best
interests at heart
• Children’s views are being taken seriously in
health-care-related decision making,
depending on their age and maturity and the
gravity of the decision to be made
Children's Ability to Make Competent Decisions
Assessment of specific competency include:

1. The person's ability to understand information
that is offered about the nature and potential
consequences of the decision to be made
2. The ability to manifest a decision
3. The manner in which the decision is made
4. The nature of the resulting decision
DECISION MAKING AND
THE CONCEPT OF ‘BEST INTERESTS’
• As children are not autonomous, the ethical
principle of beneficence is raised in health-care
decision making
• ‘Best interests’ mean the ‘highest net benefit
among the available options that apply to any
situation in which a decision has to be made
regarding the health of the child’
• If the treatment offers considerable benefit to the
patient and poses a low risk, it is generally thought
to be in that person’s interests
There are five key elements in fully
informed decision-making
1.Information refers - to access to all data
which might reasonably be expected to
influence a person's willingness to participate
2.Understanding – the ability to weigh potential
outcomes, and also the foresight to anticipate
the future consequences of the decision
3. Competency - includes the capacity to
understand
4. Voluntariness - is the freedom to choose to
participate or to refuse
5.Decision-making - refers to the ability to
provide a reasoned choice and express it
clearly
CHILDREN AND CONSENT
• As children grow older and mature, they

develop the capacity to be involved in making
decisions regarding their own health care
• children as young as 7 years old may be able
to be involved in medical decision making
• Infants and very young children lack the ability
to make decisions
• Older children are developing decisional
capacity
• Teenagers generally have developed decisional
capacity
• It may be difficult to judge the child’s capacity
to make a decision and there are no clear
standards for judging competency
• It is difficult to force treatment on a child who
strongly objects to it and is old enough to
understand ,especially if the treatment has
marginal benefits and significant side-effects
• Young people who live separately from their
parents, manage their own finances, are
married or have children of their own, and
these young people are regarded as fully
autonomous
OTHER IMPORTANT ETHICAL ISSUES IN TREATING CHILDREN
• Disclosure of information to children should

be truthful and should encompass relevant
information regarding their medical care,
presented in an understandable way
• A dilemma could be created if the parents do
not wish certain information to be disclosed to
the child, e.g. that the child is HIV-infected
• Confidentiality in medicine is very important
and promotes respect for the patient
• Difficult situations may arise if a child or
adolescent requests the doctor not to inform
the parents about contraception or pregnancy
REFUSAL OF MEDICAL CARE
• If the child and/or parent refuse medical

treatment or an intervention that is of limited
effectiveness, especially if that therapy or
intervention also carries significant risk or
severe side-effects, then the doctor should
respect the decision
• If the child agrees to the therapy but the
parent disagrees and the doctor believes the
therapy is in the child’s best interests, the
therapy should go ahead
• A more difficult situation arises where parents
refuse beneficial and safe interventions, such
as immunizations
There is no simple solution when health care
providers feel that medical decisions made by
parents are not in the minor’s best interest, but
some principles are always helpful:
• Maintain an ongoing dialogue with the parents in
order to avoid misunderstanding their directions
and their rationale
• Avoid confrontation; parents’ emotions are
understandably strong
• Explore any alternatives to the Doctors’
recommendations that might be acceptable to
the parents or might alter their decision
• Consider if consultation with the hospital’s
ethics committee might be helpful to doctors
or parents, either separately or together
Summary
• Define what is dilemma
• Who should decide for children?
• Best interest of the child
• CHILDREN AND CONSENT
• Disclosure
• What to do when the refusal of medical care?
Thank you

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Ethical Dilemmas

• Ethical dilemmas occur when patients and

• Children are not autonomous and therefore

Assessment of specific competency include:

• As children grow older and mature, they

• Disclosure of information to children should

• If the child and/or parent refuse medical

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